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0131 MAIN STREET (COTUIT)
�/ l�1�•� �I�r�'cf i J r TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map d y: Parcel001Application #� Mrs Health Division Date Issued ?/� Conservation Division Applicatio e 1--7 4,61 Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board r Historic - OKH _ Preservation/ Hyannis EYE AyL SENT Project Street Address Aid 5+ret+ Village Owner 'VAl9A Address 131 MAIw Sfi•Cv7wt�1N� o2(o3s' Telephone R� �re%a nest v �gj k a u%�All a u1 f�C 6 ?Ve sou�e�.`"t✓Pw�'Pd. 64 Sri Jet/ �i Flo l2"'X " Per itquest � � .e✓ d P�v/ y Dee T Soim u e-5 7o vea✓ 411 o4- B A A d 6A✓A e JTydCfuK6tAM# Vc fdl lei Q� G �U{u/ fl y�'ll/gll �/�Ivrr ti covtify l3Uor �EyfQ le evtiJT i!9 �111400,is e a P goy a� eN fi2a�/t Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District t' Flood Plain 4)14 Groundwater Overlay A)o � Project Valuation OD 0 00 Construction Type W00®F/t.4me �vl Lot Size 3 �� �r Y� Grandfathered: ❑Yes ❑ No If yes, attach sun �� ocumentation. �AY� Dwelling Type: Single Family G7/ Two Family ❑ Multi-Family(# units) Age of Existing Structure ��� Historic House: WIYe�� ❑ No On-C�'l, s ig�`�wa : ❑Yes QNo S of%�?'�2`'CSq� � v, Basement Type: ❑ Full ❑ Crawl ❑Walkout Other qB�z Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) 9 Number of Baths: Full:existing new 6 Half: existing i new 0 Number of Bedrooms: 3 existing v new Total Room Count (not including baths): existing 7new O First Floor Room Count Heat Type and Fuel: ❑ Gas W/Oil ❑ Electric ❑Other Central Air: ❑Yes ;YNo Fireplaces: Existing ✓ New 0 Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Q Attached garage: existing ❑ new size _Shed: ❑ existing ❑ new size _Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes L4 If yes, site plan review# Current Use SAM& r4 rnI/y Proposed Use _Z? ,. APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name �'94eJ 11C(o6wdc�- Telephone Number 9s'/t C4 fi 22i dl)oz Address /(eq5� Vew vwft Al License # CS C0AJJJ >Y,4 0X63 Home Improvement Contractor# f 007 VO 11 Email Jl m Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE -- J FOR OFFICIAL USE ONLY APPLICATION # DATE ISSUED MAP/ PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. Page 7 of 7 Capizzi Home Improvement Inc. Specifications and Estimates STATE OF MASSACHUSETTS LETTER OF AUTHORIZATION TO APPLY FOR A BUILDING PERMIT I, VAIRA HARIK, OWN THE PROPERTY LOCATED AT 131 MAIN STREET IN COTUIT, MASSACHUSETTS. I HAVE AUTHORIZED CAPIZZI HOME IMPROVEMENT JO ACT AS MY AGENT TO APPLY FOR A BUILDING PERMIT IN ACCORDANCE WITH 780 CMR, THE MASSACHUSETTS STATE BUILDING CODE. I GIVE MY PERMISSION TO LESSEE TO APPLY FOR A BUILDING PERMIT IN ACCORDANCE WITH 780 CMR, THE MASSACHUSETTS STATE BUILDING�O E. SIGNATURE OF OWNER: II, OWNER'S ADDRESS: 131 MA STREET COTUIT, MA 02635 OWNER'S TELEPHONE: (52.0)271-6314 LESSEES SIGNATURE: I LESSEE'S ADDRESS: LESSEE'S TELEPHONE: APLLICANT'S SIGNATURE: APPLICANT'S ADDRESS: 1645 Newtown Rd. Cotuit MA 02635 APPLICANT'S TELEPHONE: . . .. 5087428-9518 RESPONSIBLE OFFICER: RESPONSIBLE OFFICER ADDRESS: RESPONSIBLE OFFICER TELEPHONE: I The Commonwealth of Massachusetts z Department of Ind ustrialAccidents 1 Congress Street,Suite 100 Boston,MA 02114-2017 www.massgov/dia lNorkers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY AnnlicantInformation Please Print Leaibb Name(Business/Organization/Individual):CAPIZZI HOME IMPROVEMENT ING Address:1645 NEWTOWN ROAD City/State/Zip:COTUIT,MA 02635 Phone#:50&428-9518 Are you an employer?Check the appropriate boa: Type of project(required): 1.2]I am a employer with 40 employees(full and/or part-time).* 7. ❑New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in 8. Remodeling any capacity.[No workers'comp.insurance required.] 9. Demolition 3_M I am a homeowner doing all work myself.[No workers'comp.insurance required]t 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will 10 Building addition ensure that all contractors either have workers'compensation insurance or are sole 1 L❑Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet 13 QRoof rep airs These sub-contractors have employees and have workers'comp.insurance.t 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.[ other 152,§1(4),and we have no employees.[No workers'comp.insurance required.] (f�f'M11010 *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. f 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. lam an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:AmGUARD INSURANCE COMPANY Policy#or Self-ins.Lic.#:R2WC527200 Expiration Date:12/25/2016 Job Site Address: 31 H4 tN f� 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 MGL c. 152,§25A is a criminal violation punishable by 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. of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage vent, o I do hereby 91,40 the airs and penalties of perjury that the information provided above is true and correct. Si ature: Date: s �° Phone#:508-428-9518 Official use only. Do not write in th s area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: �►co CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYW) 12 29 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: ROGERS&GRAY INSURANCE AGENCY, INC. PHONE Fax AIC No): 434 Route 134 E-MAIL ADDRESS: INSURERS AFFORDING COVERAGE NAIC# South Dennis MA 02660 INSURERA: AmGUARD Insurance Company- 2390 INSURED INSURER B CAPIZZI HOME IMPROVEMENT INC INSURERC: 1645 NEWTOWN ROAD INSURERD: INSURER E: COTUIT MA 02635 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 CONTRACT OR 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. I�TR TYPE OF INSURANCE INSR$UBR WVD POLICY NUMBER MMLDDIIYEYW MMIDD� LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY PREMDAMAGE RENT D PREMISESS(Ea occurrence) $ CLAIMS-MADE OCCUR MED EXP(Any one person) $ PERSONAL BADVINJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOPAGG $ POLICY PRO-JECT LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIWIr— (Ea accident ANY AUTO BODI LY I NJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PR dTntl $ PER DAMAGE HIREDAUTOS AUTOS (Pero UMBRELLA LIAB HOCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DIED I I RETENTION$ $ A WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY Y/N R2WC655250 12/25/2015 12/25/2016 X ITR ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? ® N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 Af 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) �E CERTIFICATE HOLDER CANCELLATION Town Of Barnstable SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 200 Main Street THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Hyannis, MA 02601 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 26(2010/05) The ACORD name and logo are registered marks of ACORD 1.1 t ` I. oil 11 qJI� j i d i.. I i.. ' _ i I i I 1 i I I I q i - GIG/ • i I t I I `. .I_ I i ! t T : 1 , 5 9 j i II E z /• I I I .i i I • .. + i I l � i I � I ! � I� r _ Lz 004 Off IJ • i � ' l� f� + I I I I I �a_'®:esmums�crva,�.+sixn:wv - I --- i i ..i.. I t + I t i ' I I • i i 1I. 1 f I I � { I ' I '.. : I i I, 1 i , , S I ! I I 'z'4 10 I VIVO , I i I. _.L.. r.--;- —/-j- •j- ,--mow,-�>�r?�. �ln. t� C', ; . _' ; , ! I I i I I ! ! I i I I I ! I { i • • ' �t �"`r+n : !� ..` i I S y I : .ups ! t ' ! i i { I i I � i I 7 ; I i I ! , I - I -.L.. I .� I •• ��%1r�' F?°•fi���'�/` � � �.,Y`_.,�c..�,�/ / �:"J3'Ar' �i-+9 I�d'Li.�,i�y�• • I i � � I I i ' , I • ,W-X" i i J ....i ..I , , 'i'-- I I I I • `K i , ... U , I JA : i I I ' ! IT tA i ! I I i I 1 ; l , i 7 Az : , �//_/��/n ?f I : . I : I i 7-tl I IJill . , cv m� I� 1 ; � ' Po , : iL . Jlr , , " , , f' i - Town of Barnstable ASTABLE. Growth Management Department g 9 P i679'6 Barnstable Historical Commission f0 MA'S . www.town.barnstable.ma.us/historicalcommissidn Jo Anne Miller Buntich, Director COMMISSION MEMBERS: Marylou Fair,Administrative Assistant Laurie Young,Chair r Nancy Clark,Vice Chair 71Marilyn Fifield,Clerk " r i George Jessop,AIA Nancy Shoemaker .. Len GObell %•'1-�i'f"t�+f-;rl r T;-,;Ss„ . -:0 Ted Wurzburg t Paul Arnold,Alternate DECISION Summary: Demolition Delay Not Imposed Pursuant to Chapter 112 Historic Properties, Section 112-3 F Applicant/Property Owner: Vaira Harik. Subject Property: 131 Main Street, Cotuit. Assessor's Map/Parcel: 009/009 Hearing Date: August 25, 2015 „ - Pursuant to the Barnstable Historical Commission Chair's determination on July 22, 2015 a duly a a advertised and noticed public hearing was held on August 25, 2015 to determine whether the significant building identified as the detached barn on this property is preferably preserved and whether demolition delay would be imposed for the partial demolition (foundation) on the parcel addressed as 131 Main Street, Cotuit. „ After review and consideration of public testimony, application and record file, the Commission by a unanimous vote, found that in accordance with Chapter 112-F the demolition of the foundation on the detached barn is not a preferably preserved portion of the building: In accordance with Chapter 112-3 F, the Commission determined by a unanimous vote that the demolition of the portions of the foundation would-not be detrimental to the historical, cultural or architectural heritage or resources of the Town. L_av,rU, Y01,t" September 4, 2015 Laurie Young, Chair Date • x, 200 Main Street,Hyannis,MA 02601 (o)508-862-4786(f)508-862-4784 367,Main Street,Hyannis,MA 02601 (o)508-862-4678(f)508.862-4782 Town ®f Barnstable Growth ilLenagement Department Barnstable Historical,Commission vnvwf.town.bamstably.ma.usrhisfaricalcoirsmissidn , 1 NOTICE OF.INTENT TO DEMOLISH-A SIGNIFICANT BUILDING s Date.of Application_� 1 Q FuII Demotion. Q Partial Demolition " i - Building Address: I3 M IV s Number street �Y1 Assessor's Map# _Assessor's.Parcel# 00 Villages ZIP ram' / Property Owner. I 720 '�' ` I 3_1 Name 7 7 Phoned Property Owner Mailing Address('rf.different than bolding address): .5k4� Property Owner.e-mail address: V►O t } K r>fl,MSN,CONI Contractor/Agent: �1 Contractor/Agent Mailing.Address: Poo 84X c Contractor%Agent Contact Name and Phone# ROaF.t2.` U V_ SDg' 36" - WIT Name Phone Contractor/Agent Contact e-mail address: r-tuyl C1�MGA- 11/ Detail of Demolition Proposed: M01/i fl G,?Jr�B4l/�(�- i�fL�C. d- ! 1 ForJnhtk'f laA1 Type of New Construction Proposedc_ ?W1? - '0AIPWF� �N .. ► t) V -- r Provide information belowto assist the Commisston`in:making the required determination regarding the.status of the Building in accordance with,Aitdie 1 .§112:;" Year built Additions Year Built Is the Building listed on the,N nal Register of Historic Places or is the building'located in a National Register.District? No . 0 Yes Pro y.Owner/Agent Signature y: May,2014, t 7/2012015 Nelson Rhodetio se Hasse-Wikipedia,the tee encyclopedia Coordinates.41°38'2."N 70°26'59"W Nelson Rhodehousemouse .F From Wiki&dia, the free encyclopedia The Nelson Rhodehouse House is a historic house at 131 Main Street in the Cotuit village of Balm stable,`Massachusetts. The 1 Nelson Rhodehouse I-louse 1/2 story Wood frame house was built c. 1858 by Charles Baxter, U.S. National Register of Historic Places a housewright,who sold it soon thereafter to Nelson . Rhodehouse, a mariner.121 The house is a fine.example of Greek Revival style,with a distinctive side entrance located in a porch that is recessed under the gable. The house is:finished in. flushboarding,giving the appearance.of masonry;with comer pilasters.l31 The house was listed on the National Reg steudHistoric Places , in 19,87.111 See also 131 Main Street ■ National.'Register of Historic Places',listirigs m-Barnstable County,Massachusetts { *--77 - References { fey tr 14 1. "National Register Information System htt .//nrh focus.n s. ov/natre doss/All_Data:html Nati nal o ( p://nrhp.focus.nps.gov/tiatreg/dci.es/�A� ll_pa#,.*html);p. p. g ) Register of Historic Places. National Park Service.200,8-04=15. ' Location Barnstable, 2. Deyo, Simeon L. 1890. History,of Barnstable County; Massachusetts. New York: H. W. Blake.&Co p. 448 Massachusetts. 3: "MACRIS'inventory record-for aNelson.Rhodehouse House Coordinates 41038121"N „(http://mhc-macris.net/Details.aspx?MhcId=BRN.302); 70026'59''W Commonwealth of Massachusetts. Retrieved,2014-05-04. ' Built 1858 t Retrieved from "https //en-.wikipedia org%w/index.php? Architect. Unknown. title=Nelson Rhodehouse House&oldid=66382139.0 Architectural:style Greek Revival Governing body; Private Categories: E ,, MI'S, Barnstable MRA, NRHP Reference# 87000308 - Added to NRHP March;l3, 1987 Houses on,the National Register of Historic Places in Massachusetts- Houses in Barnstable.,Massachusetts National 'Reg gister of Historic Places in Barnstable County,`Massachusetts MmJten.Wikipediaorglwiki/Ndson.RhodehoL*e House 1l2 Towr.of Barnstable G 'hic Information System A64M, July 20,2015 009013 #77 023008 009012001 #92 t 23009 ODS021003 Q11�015 #93 #4821 009012002 #38 023010 #120 J O09012003 009011001 #52 #115 r 023011 + e?: # 34 i 009011004 . >- #1825 Y • #53 � � _.ti. 023066 148 009011003 r«. # L 47 ✓ a 023067 k "r #160 31 47 i:.*tt Y. .•1� ,��, � fAa v v �'��v�.,y„'r��£•'' t ''^r^ '~ rc'i' - � #8 #30A sue` L� y ��'� r 1 �£,'at , f'j k`�k''r�a � .$�� �'�,� �� iY,;�:•,- ;;r,; � �'�� 023oz8 ,t : xtiE. , •#r •t E? ^t 009025:' <,� r.� a� fit• � +•L;."r ';.r1' � .:,�'�i`�x'" r'� ��-r, ��' �` •ems' •rr .'r �,- 023068 ' ; #191 00903 ~ 4_' =w 023002 009006001 #35 OO9D0600n' r St i #75 022071 022070 a - 0>3001 0 80 Feet 022072 iF 34 - �� 1176 #215 DISCLANIERS:This map is for planning purposes only. It is not adequate for legal Map:009 Parcel:009 a Selected Parcel bourdary determination or regulatory interpretation. Enlargements beyond a scale of Owner:HARIK,VAIRA Total Assessed Value:$371 B00 i'=1 00'may not m parcel meet established map accuracy standards. The lines on this map E - w� are only graphic representations of Assessor's tax parcels. They are not true property Co-Owner: Acreage:3.64 acres Abutters ' bourda•ies and do not represent accara!e relalionships to physical features on the map Location:131 MAIN STREET(COTUIT) - suck as building locations. Buffer Aeriai Photos Taken July 10,2009 �';* �ELK. y� f i•.'K, � "°""-' . � � '+- � '.�'�F '' �''�•'' � 1 , t'�f'�".� � �► All ow ` Y Al Is me IN 1 4 G er. tF ip ca • '1V7 tom'• - � i W.0 ',� .t'�•,-sw"'.'•�` �, ��, tt \ 4+.�'M v"y'�c s� Y{�r + dF+f-Y�d(r ,f ''r!:\a"' v If le e' fo _, �, ..,.fit •'-�. t il.raw,..,F;r n .c _ !;:' • el"�v-*- -� t[.,.J-' -47 y t r tr .. r .3 j. 411 �r wwa f. ..__ .___- _.-. •- Y.-. j- a ♦� r ? •4. aE'. .,,, �. � marts !LL_..:� „fig....�._ .. .... -.<.,.:� ... - Atm.MMP _ �+AS AL V a- ai ITT .� f� f •,Jr� i • ��y•. _.,. � ., ice- v • � �.♦ is e. x! .�t, _ 1 r s:. . • \'. 4. �K-� M• �- '' f v." •fir -:�� ``� � �-�. * . n -.l—A . fir.T.-' la � � r� • -_OKI 1. t.rlrll� t +a 4 NW T 40 <, ._ F ;a� g'•+ ,N�;.. ,�� •. �ti fir' .^�', fyy 1 � '�•, _..r .i P .. - cx s. - .t ... � �•.. � - `i t t s� y .� �,- a �, i it � � 4 i 4�y� _,. .'1• a _ 1 i< F r- • q �tp: .y.- Syr-• '` ��_4 t �, -1 -� '�•.� JAR "•`.5 }a. � ` -S+ — r YTS•. � YF� �r _ r r y��✓ TV .r�� `T `- - �-- — � r Oil =•'r- -'=--t .1: i� ,ram--��"',.sy� �'�. �'-�--, --- - _ / r 1 ,lr x ,s•st .. � S r� I r �• � -YR. �. ,1 t •!7� S - 7 , e � 1 FT �_. ��!. .; . fit• \N b x, 1 P'� 1 '�� \ a t ' 'r � *y,f bow•a'�'�'�� ^n ^� ? �3�11X�tt �'•a^��� �\}1 1 - _ I 1 I� t� t� r � r s `y d 2 if 6��1 -N •fn { � _ y ,W-% —say-_;. t . 1 y-- Tv {. .,.r� ilk - y . k Owner: Vaira Harik 131 MAIN STREET, COTUIT MA FLOOR PLAN Barn is described on Assessor's Map as "UHS (Unheated Structure) GAR (Garage)". Floor joists rest on a combination of 8" brick pillars (east and west sides) and 3 or 4 course brick foundation walls (north and south sides). Barn will be lifted and concrete foundation poured. S � �'DK 27 15 GAR 0 P 15 y 24 ` 111 A _ --- 5 1 - I_ Y� '1 _ QS I PAIS r `1' _r4 � r �� j '= Massachusetts Department of Public Safety lowBoard of Building Regulations and Standards License: CS-076261 f Construction Supervisor JAMES MCCORMACK 73 FEARING HILL ROAD WEST WAREHAM MA 02576 r,�-IZZK CA, Expiration: Commissioner 11/13/2017 • �e.�o»rnenreruerrl!/r n�O/jl�rr.uac/e�rtetf _ —Office of Consumer Affairs&]Business Regulation ]L,ecpnse or registration valid for individul use only ME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: ®ice of Consumer Affairs.and Business Regulation eglstration: 100740 Type: ]101Park Plaza-Suite 5170 Expiration: 6/23/2015 Supplement surd ]Boston,MA 02116 ' CAP1771 HOME IMPROVEMENT,'INC. JAMES MCCORMACK 1645 Newton Rd. Cotult,MA 02635 Not valid without signature Undersecretary L , r OF IME ucneyr WWWrABLE• Town of Barnstable ' __ R" '°Teo► "�� Growth Management Department '` I"'�- 4 Barnstable Historical Commission 0:1 C; .T.t!? __4 www.town.barnstable.ma.us/historicalcommission Jo Anne Miller Buntich,Director Marylou Fair,Administrative Assistant' 4 COMMISSION MEMBERS: Laurie Young,Chair a � Nancy Clark,Vice Chair ;. Marilyn Fifield,Clerk George Jessop,AIA Nancy Shoemaker :. Ted Wurzburg Paul Arnold,Alternate a July 22,2015 Re-' Intent to Demolish Portions of Attached Barn 131 Main Street,Cotuit Map 009, Parcel 009 - Vaira Harik 131 Main Street Cotuit, MA 02635 Ann Quirk,Town Clerk 367 Main Street, Hyannis, MA 02601 ; Thomas Perry, Building Commissioner 200 Main Street, Hyannis MA 02601 ; Pursuant to the attached decision,please be advised that the Barnstable Historical.Commission will hold a public hearing on this matter on August 18,2015 at 4Zpm, 367 Main Street, Hyannis,2nd Floor,Selectmen's Conference Room. This public hearing will be advertised,notices sent to.abutters and a notice form will be posted on the building or. other visible site on the property The applicant is responsible for advertising and,mailing costs associated with the pubic hearing. ; Please contact Marylou Fair at 508.362.4787 or marylou.fairQtown.barnstable.ma.us for processing information. Sincerely, Laurie K.Young,Chair 200 Main Street,Hyannis,MA 02601 (o)508-862-4786(f)508-862-4784 367 Main Street,Hyannis,MA 02601 (o)508-862.4678(f)508-862-4782 KE 1 I �, Town of Barnstable Growth Management Department ``"r + iARNSPABLE. .L:,It••.Ie�=i Jy�L.i_ I i—[t1;!� �_:``. MA& Barnstable Historical Commission 6'01c.'iJ; www.town.barnstable.ma.us/historicalcommissicin Jo Anne Miller Buntich, Director COMMISSION MEMBERS: Marylou Fair,Administrative Assistant Laurie Young,Chair George Jessop,AIA Marilyn Fifield,Clerk Nancy Clark,Vice Chair Nancy Shoemaker Ted Wurzburg Paul Arnold,Alternate Chapter 112 Historic Properties, Section 112-3 D. DETERMINATION of SIGNIFICANT BUILDING 131 Main Street, Cotuit Map 009/Parcel 009 Pursuant to Intent to Demolish Portions of Attached Barn The Barnstable Historical Commission received a Notice of Intent to'Demolish application for this address stamped by the Town Clerk on July 21, 2015.. This property, located at 131 Main Street, Cotuit, known as the Nelson Rhodehouse House was built in 1858 and is a National Register Individual Property listed 03/13/1987. It is associated with the broad architectural and cultural history of.this area.. ;; s In accordance with Chapters 112-2 and 112-3(1)), Barnstable Historical Commission Chair has determined that this structure is a significant building. 200 Main Street,Hyannis,MA 02601 (o)508-862-4786(f)508-862-4784 r 367 Main Street,Hyannis,MA 02601 (o)508-8624678,.(f)508-862-4782 ` Towh of Barnstable } q( E Growth Management Department Barnstable Historical Commission www.town.bamstable.ma.usmistoncalcommission ' NOTICE OF INTENT TO DEMOLISH,A SIGNIFICANT BUILDING Date,of Application S 0 Full,Demotion Q Partial Demolition Building Address:131 IV S7 Number Street �1 r Assessor's Map#(bI Assessor's Parcel# 00 Village ZIP N Property Owner: Name Phone*. .. Property Owner Mailing Address(if different than building address) S /�l Property Owner e-mail address: VN� Contractor/Agent: y4DWG l�l lf' S, �I NG Contractor/Agent Mailing Address' P,0.:3 / 'T7 �1� I /`� � ?JS Contractor/Agent Contact Name and Phone#: RoaE4e1 . tTrt'Yl i/V 5 o 36't b3 8 Name Phone# Contractor/Agent Contact e-mail address:NIELL F_IY� CDMC.A- l1� � Detail of Demolition Proposed: 0�/#�-)L ,_ f7 ���ly�YGiC d' P►1.�� ��Nt��kTl L�AI Type of New Construction Proposed: CO/�� 1� AND 1 v WAJ vi'Z,� rz r &4o Provide information below to assist the Commission in making the required determination regarding the status of the- Building in accordance with Article 1., § 112 / Year built: 1gsg Additions Year Built: Is the Building listed on the N nal:Register of Historic Places or is the building located in'a National Register District? No Yes . Ptop4r Owner/Agent Signature May:2014 7/20/2015 Nelson Rhodehome House-Wikipeda,the tee encyclopedia Coordinates:41°3812"N 70026'59"W . Nelson .Rhodehouse House : From Wikipedia, the free encyclopedia 4 The Nelson Rhodehouse House is a historic house at 01 Main Street in-the Cotuit village of Barnstable, Massachusetts. The 1- Nelson Rhodehouse House 1/2 story wood frame house was built c. 1858 by Charles Baxter; U.S. National Register of Historic Places a housewright, who sold it soon thereafter to Nelson �� k Rhodehouse a mariner. The house is a fine example of Greek Revival style, with a distinctive side entrance located in a porch that -, ts recessed under gable. The house is finished m flushboarding, giving the,appearance of masonry, with corner - pilasters.[3] } The house was:listed on the National Register.of Historic Places in�1987.111 Street See also 131 Maur. t et ■ National Register of Historic Places listings in Barnstable County,Massachusetts 1 -► References , , a 1 "National Register Information System" h .(http://nrhp.focus.nps.gov/natreg/docs/All Data.html)...National r QA { °x Register of Historic Places. National Park Service. 2008-04-15. Location Barnstable, 2. :Deyo, Simeon L.:1890. History of Barnstable:County, Massachusetts. New York: H. W: &Blake Co. p. 448 Massachusetts: 3. "MACRIS inventory record for Nelson Rhodehouse House" Coordinates 41982"N (http://mhc-macris.netMetai1s.aspx?MhcId=BRN.302): 70026'59"W Commonwealth of Massachusetts. Retrieved 2014-05-04. Built 1858 Retrieved from "https..//en.w.1kip.edia.org/w/indek..php? Architect Unknown title=Nelson Rhodehouse House&oldid=663821390" Architectural style Greek Revival Categories: p Governing o Private G erning body t P ' .. . NIPS : : . Barnstable MRA NRHP Reference# : . ' 87000308 111. Added to'NRHP March 13, 1987 Houses on the National.Register.of Historic Places in Massachusetts Houses in Barnstable, Massachusetts National Register of Historic Places,in Barnstable County, Massachusetts httpsl/en.Wikipedia.org/wiki/Nelson Rhodehouse Home 1/2 Town of Barnstable Geogjjjbic Information System July 20, 2015 009013 #77 023008 023009 021003 009012001 #92 #108 009 #021 009015 093 #53 009012002! #36 � - 023010 1 „ #120 009012003 009011001 #52 #115 - 023011 #134 009011002 , - #29 \ 009011004 ' `tom- 023012 #53 #1825 r� 023066 _ ti#148 009011003, + #45 023067 i 009009 r#160 #131 C `r^ 023029 � ' #8 009008 #30B 023027 #151 009025 #50 023068 t 009032 #80 sr �� 023np_ 023069 009006001 #35 009006002 #75 022071 0 80 Feet #95 # 022C 022072 4 2� C r'C' DISCLAIMERS:This map is for planning purposes only. It is not adequate for legal Map:009 Parcel:009 Selected Parcel EJ boundary determination or regulatory interpretation. Enlargements beyond a scale of Owner:HARIK,VAIRA Total Assessed Value:$371800 1"=100'may not meet established map accuracy standards. The parcel lines on this map W-. = E are only graphic representations of Assessor's tax parcels. They are not true property Co-Owner: Acreage:3.64 acres Abutters µf• boundaries and do not represent accurate relationships to physical features on the map Location:131 MAIN STREET(COTUIT) such as building locations. 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I i Owner: Vara Hark. 131 MAIN STREET,COTUIT MA FLOOR PLAN Barn is described on Assessor's.Map as 'UHS (Unheated Structure) GAR (Garage)". Floor joists rest on a combination.of 8" brick pillars-(east and west aides) and:3 or 4 course brick foundation walls:(north and south sides). Barn will be lifted and concrete foundation poured. wr fo� U H w ., �. a o Z 131 /41a4 &dL . Town of Barnstable "Permit N to `i Z IG�bu d maethsJMm issue dace a ■,►rartsrwt+uf; i regulatory Services Fee nABO' p Thomas F.G+eiler,Director ie79' e,`P Building IC Division : Tom Perry, Building Commissioner PRE 200 Main Street, Hyannis,MA 02601 h 2004 Office. 509-862-4038 (�A� Fax: 508-790-6230 R.�jSTRS( EXPRESS PER%GT APPLICATION - RESm)E1 Not Valid without Red X-Pruj Tmprint Map%parcol Number I �r� Paoporty Address l,. )kOAn Q S �fl' 1� �1 t hC�d a Residential Value of Work 10, Owner's'Naux&Address -OS 60CWA1\) Contractor's Name-�G.>J J LU.Z2 C�t�( �} `.�(lSO�► Telephone Number Home Improvement Contractor License#(if applicable) �U Construction Supervisor's License#(if applicable) a(p 5Workm20's Compensation Insurance Check ouo: ❑ I am a solo proprietor I am the Homeowner I have Worker's Compensation Insurance Insurance Company Nacho U'G U C>�L� T'1CS,�(�\1 -1 .0O, 0� Worlanan's comp.Policy if `I PJ U 6 q'@ a X Permit Rrquost(chock box) Re-roof(stripping old shingles) All construction debris will betaken to ��L ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-aide [] Replacement Wi:adows. U-Value (maximum.44) ❑ Other(specify) *Where required. Issuance of UW pa vit does not exempt compliance vnth other town departmecu ngutaaons,i.e.Histaric,Conscrvatian,nth. r r• Signatur Q:Famru:e*tntrg Revisedl21901 O t Property Owner Must Complete & Sign TNs Form If Using a Roofer / Builder. (Please return this form with your signed contract, thank yoga) l (print) V P�FA *4- 'irj -8o C4)0 r as Owner of the subject property hereby.authorizes Paul J. Cazeault & Sons Roofii Inc. To act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of Job) IN � )( A/ S�� Signature of Owner.—JmLe ----------- Date `� Tex 641 The Comns(?rrsvealth of Massachusetts Departnfent of Iridusi'rial Accideats . ®ffa1G��ll176't.SGtyBdl���' . - — 600 Wavhingto,r Street . =� 13aslotr, Mass. 02111 Workers'Comp ensatioil Insurance Aff davi It AA ❑ I am a homeowner performing all work myscif. �Itotub -5_. ❑ [am a sole proprietor and have no one working in acay cau,acity ilI1fi11il�a [am an employer providing workers' compensation for my cml)loyecs working on�U,issjj,; �� .,..»..:;... : :.. .. . €�B1Bi�lUa�1Ta111�$9�t6t�ii$Ifl�lutl,Q... • N• nhono N 7.� ❑ [.am a sole proprietor,general contractor, or Iwmco 52 Ilf�Yi `. the fol.lowin ncr(circle ane)atad have hirca the contractors listed below who I;a, g workers'•com . .. Pe on polices: t III(any.11amF;' ••• -•.• .. .. ... . : . .. . .. ....:.. :.::::..:. 'bOrCl'�l�•� :..>. ... . — - .... . .. :.. .......... .... .:. �4111nanvnsmr.• .. .. :..:.... . ... l Ta 1lw ---r. 1aS1i1Cy: '' Failure to secure coverage as required under Section 25A of 111152 can lead to the impostition of crimir ai penalties of a line u to$ � one years'imprisoamtat as well as civil Penalties in the form of s STOP\PORK ORDER and a fine of sI60.00 a day agaias;Inc.�i undSrOsaaJ llaa),a copy of this statement may be forwarded to the oMce of Investigations of ttae DIA for coverage verificago,a. d do h ere b cc 1 p Y fY nde (h pains nd penal ' of perjury that the Information provided above Is rue and cvrren: Sigiiatu Q Date 1 04 :Print name — Phonc.N.i� official use only do not write in this area to be completed by city a town o )1 �$� ` city or towns .a ' -- _: permlt/IlcenseN ;� Q check if immediate response is required ---OBuilding pcpartwcnt , t]Uccasing hoard QSdcc(III Ofrcc contact person: ❑11caith Department ' phone N;` ,S 4-vised says PJA) [nform,ation zind Instructions Massachusetts General'Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the"law", an employee is defined as every person in the service of another under any contract of hire, express or implied, oral or written. An employer is defined as an individual, partnership, association, corporation or other legal entity, or any two or morc c.�f 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 cmplc►yces. However the owner of a dwelling house having not more than three.apartments and who resides th.rein,or the occupant of the dwelling house of-another who employs'persons to do maintciiance, construction or 1-cpair work on such dwelling thous, or on the grounds or building appurtenant thereto shall not because of such ernploym;nt be dermal to be all s;.mploy el MGL chapter 152 section 25 also states that every state or local licensing agency sb all withhold the ii-sua►ice or renewal of a license or permit to operate a business or to construct buildings in ilae coulruonwealth for an applicant who has not produced acceptable evidence of compliance with tine insr:Mice rec ui coverage g l tLc1. Additionally, neither the commonwealth nor any of its political subdivisions shall ens er;into an),ccntract for the performance of public work until acceptable evidence of con..1plianee with the'insurarice requirements of this cha ptcr F:1. ball l presented the contracting authorit y. Applicants Please fill in the workers' compensation affidavit completely, by checking the box ti;at applics 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 acid date the afltidavit. The affidavit should be returned to the city or town that the application for the permit or liccu.se is being;requested, not the Department of Industrial Accidents. Should:you have any questions regarding;the"law"or if you are reduircd to obtain a workers' compensation policy, please call the Department at the number listeri below. City or Towns1 � � 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. Pleas( be sure to fill in the permittlicense number which will be used as a reference number. The afl:idavits may be zeturned 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 :rid sliould you have any questions. please do not hesitate to give us a call. The n.Dopartment's address, telephone and fax_suite_ �;{r. : The C► F.it �::c4tZt;►s�;., ncpartrt ell a!Ace-4 tlt�cn i�f�rluCstl�alloQ�S • 600 Washington Street Bosto a, IIM[a. 02111 DATc I)awD1uY I) i ACORD . `CERTIFICA rE OF LIABILITY 9NS4. RAN(.`fE PRODUCER i ~T K; CERTIFICATE iS ISSUED A3 A 1AATTER OF 114FORMATION ONLY AND CONFERS NO RIGHTS UPOIN TRIE CERTIFICAT c XcShea Inourance Agency, Inc. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND 01>, 749 Mmia Street, Suite#H __ALTER THE COVEFIAGE AFFORDED BY T91L Kti.ICIES BELOW—. OE;tterville,. MBt. 02655 INSURERS AFFORDING COVERAGI i 50 8=92AL 9 0.1L-: ----- - --- INSURED Paul J Cazoault & Sona Roofing IN�,L,RLfI g Illc. A-.—_W0>ilts]�Ia,�dAs33__.tx�..� INSUI"RD Tr.mvs�ls:,r. __1ndmmD— _ Ca-ol.-IlliuQ�.__l lO3l Main Street I IN URF:R C — 00terville, ma 02655 ;IN',UR(R D_-- -- - --- - --- - ipnn--fi9FI:—s[SGU IN'i1JHI A COVERAGES __---- THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THI'-INSUFIED NAMED ABOVE FOR IHE POLICY PERIOD INDICATED ND i WITHSTANDING ANY REOUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT 10 WHICH THIS CFPTIFICATE MhY DE ISSUED 01-1 MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCHIBFU HERE;N IS SUBJECT TO ALL THE TERMS.EXCLVSIONS AND CONDITIONS OF SUC)' POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAtO CLAIMS INSR - - - P(1LIl:Y EFFECTIVE POLICY Ex PIRATION - urnn B - ——""_-- TYPE OF INSURANCE POLICY NUMBER 147E MWJ E MAVUD/Y _ GENERAL LIABILITY EACH OCCORHENCC x COMMERCIAL Ut NFRAL LIABILITY - -TIRE DANIA0E tAnY one tire) S CLAIMS MADE I OCCUR MGO EXP(.'Ay one Porcon)".._ S A _•- SCP0467325 G4/30/03 04 30/04L PENSONAI A.ADVINJURY S 000�4100 _ .. 1 GENEHN-_GGRFGATE 5 1)4(�-_ G EN'L AGGREUAI It L1MtT APPLIES PER. PRODUCTb�COMPAOP A(:C• $1..-0.49 (�L4 POLICY ~RO- LOC JCCT AUTOMOBILE LIABILITY ---{II^ r—l-- "�� —_-- I � COMUINf.D SINGLE.LIMIT g ANY AUTOALL OvVNF.0 AUTOS ROOILY IN IURY S SCHEDULE AUTOS IPe,Pen"', HIRED AUTOS BODILY IN,IUR'! % NON-OWNED AUTOS - - (Poe aze.-I,e) I • - PROPEN ry DAMAGC S (Per eccit1wrt) GARAGE LIABILITY - -- AUTOOrtL'f LAACCIDEFIT 1, ANY AUcp � _.--- ----- OTHER I HAN EA ACC: $ AUTO ONPrf. AG' S - EXCESS LIABILITY tACH 02111/PNENCE S OCCUR ;CLAIMS MADE AGGREC.i%IE 5 ---- a DFOUCTIDLE --- Rt(FNTION --- S —_— W(STAT . IT,. WORKERS COMPENSATION AND r X[ T IY(LIMITS EII EMPLOYERS'LIABILITY 7P.7UII_922X653-502 _ 30/l0/03 oS/10/04 I E.L.EACH ACCIDENT S B ( E.L.DISE^3C-EA EMPL(l Y(.E S OTHER E L DISEASE_POI ICY UM1T S;[' �.0 _ DESCRIPTION OF OPFRATIONSILOCATIONS/VENICLEFdEXCLUSIONS ADDED DY LNDORSEMEN fi8PECIAL PROVISIONS � I i I I i I _ I CERTIFICATE HOLDER ADDITIONAL INSURED;INSURER LETTEN_ CANCLLLATION _ SHOULD ANY OF THE ABOVE DESCRIBED VOLKJES BE CANCEI-LeD BEFORE THE E W114ATION DATE THEREOF,THE ISSUINU INSURER WILLENDGAVOn TO IAAII- lA__ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMEU'1.0 THE LEFT.OUT FAILURE 10 DO°0 SIIALL IMPOSE NO OBLIGATION OR LIABILITY,OF ANY JNDON i111 INSURER,ITS AGI.NT7 OR REPRESENTA I S.AUlHORIZEDR REACORD 25-S(7/B7) 6)ACORP CORPORAT101I IA®0 il: i, 2� �l'J�t!?/I�w�t'7�r'✓J''< rC,l I ' , t.'!'/�r':J Jf,f% r�,i�l;J�.`rfC{1. BOaI-d Or BLIli ldill RC'L'LI LIIIOIIS �Hld StallCku ds !!`{ /;;;� One Ashburton Place - Room 1301 Boston. I'Aassachusetts 02108 Home Improvement (:ontractor Rej�yistrati011 Registration: 103714 Type: Private Corporation Expiration: 7/9/2004 PAUL J. CAZEAULT & SONS, INC. Paul Cazeault P.O. Box 2781 Orleans, MA 02653 Update Address and return card. \'lark reason for chanl,c. Address i I Renewal I I?ny/loy lien( Lost ('ard it Board of Iiuildiiw Regulations and Slantlards� Liccusc or registration valid for iudivitl�tl use duly HOME IMPROVEMENT CONTRACTOR before the expiration date. If found rcturu lo: f l3u:u d of 13uiltlin Itc uLlliims:uul Sl:�nila rds Registration: 103714 k � Expiration: 7/9/2004 01w AshburUm Place Rnl 1301 Type: Private Corporation 13us11 on, la.02108 PAUL J.CAZEAULT&SONS. INC. Faul Cazeaull 22 Giddiah Rd. �� rI .000i/o�zare/ue/zlU o/: ��raur�r�deCGt Orleans, MA 02653 Ad,,,;oisUaUlr Nu BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number:CS 026325 B i rth d a to: 10/20/195 9 Expires: 10/20/2005 Tr.no: 8603.0 Restricted: 00 PAULJ CAZEAULT _ 1031 MAIN ST OSTERVILLE, MA 02655 Administrator hoard of E►uildin e ulationc> �- - One Ashburton Pace " --/ m 1301 Boston, Ma 02108-1618 License: CONSTRUCTION SUPERVISOR LICENSE Birthdate: 10/20/1959 Number: CS 026325 Expires: 10/20/2005 Restricted To:.00 PAULJ CAZEAULT 1031 MAIN ST OSTERV I LLE, MA 02655 Tr. no: 8603.0 Keep top for receipt and change of address notification. r/••,/r i •.��, .rj r_,///:`�r.:, i///ir...,/r. /r. r.✓.//ir rr /ir /r/ ri r. i/r//i r/ ,?' /--//';: /CO RL-eAr r 5:;fvY1'0-2fi5 }/ rrii '�' i r [.. / ��'ATE, 0DFIV� 1 : ^/- .. 8 r/ •./ ( ";// y % {, O '� I Gi�.ti.1.Z ri /;����:;lyl��� Tr1'L 417„Y`; '6 ,.. /,:, l ,F,; / / r,, / r//v. / r�"•'r///r r�'/r i// - / ',. : / / /r /;r • / r /. ,, r//�. .7 /r! / •��r.i ;.> / / i, / .i;/ ,r ! i '� /-[ 'r/.., �;/ rrr r r rjrL/r,rr /%r/ r/ ii4/r, /, / (r'.•. r///i.r/:/ _/r..// i L/r9 ., � /:i� ;•"t/ '(/j!-� r:jr:%r f r , . r,//. i, i „Y,` ..r /,/•; /•.: r: / >.�?, / 7.'; / r /1/r ,i/•I m % t /(•i,����T�%1;i"��i//yii.:z r �d /ii/ /� �rrrrj , ,./rr r/ rr;. / �; /%, ./ri% ,./,j ri,,.'r / /i i f+.�`r.,,r r/j„ /AF-DERFr r: LJ Orf�3 s#�b1err w r i/ 7i / /w r r /. f/. w /✓/�!rii//��.r, ;.✓/.. r-/ / i /r/i .!,. qi i r r/ •r r�. /'i / :� -/i. / /i' r/ //��i //i%� � /•` 'r,. �r i ;rY �r .r.. _ � f / �_ !ii/ / �/i'r /r-r'r (. r ! � /.✓ / r - r { �r r-Lr � / r ; r/r% /l ...� ,/ /r//.,.r / rf/ //ry/ i.�j-.-r /l / ':, r -/. / i: ' �r N/ rr � :✓ /✓ r / j"% //.�' �OLL/A'RS' %, 1r: /.,%r �// -.%•!�:'ri'' ri,r� /r. .%(i / .r r. //`y r r .(/,'r� �/:�/ i y rr /i ,//r `..,7// / /?rr r,;// F . i�S //., /,//,..r •.,it��,/!, ,�.r./9/j'/ /r/�' // r r.. � i;' /, //, r/jif//r /�i.ir!y d/ .i` ,%% rr ��%//.,�/; /%i '/,'r/r% / :.,`%. //r./ r/ /T :>4 •-��fj� rnstt /--f .- ���i.i r/'�<i•':f% , 7 /../i / ,fir i '%�r/�%//�/ i'• % r% ...%: r 7. e err .n./, // '�'%r - 'y. �/i/�:i // i/ %/a (%•r/ /r;:-��. //: , //ir, rr�/':!�'Q/:,.•/�/L 1,.. �/ /%, r.� / r. /..,,_ i rii�i•�. :.✓7/- %r j, ,/,i/ !. /- /rir,cj//r/r /r /,/ -// / r/� r 'r•/.•.�. r /- G• it .// !r �,,. f� fi.,/,/f:/� i 9r -�i� � /i,: / ,j/, //,i'• �/%„ /,j.-raj/r�fir"•5 %rrr:/ �':r�%/;/, ('i,.rr /.a roi //r/ ��i / r�:,/.i?'..i�'� ./%r.// / /i'i':•i r�r(i., %% r'/rr %fir:�;,"%n% / // •r�r t; / rr / //%r: J rJ���'MlJ /, /rl /r //r/i './/>r/.,// % / rrr':•.r. -/„/ //„' r. r:r �, / r .. ./!r /rrr i/i r:/ / r,% /,.!. r!7 .r ;,:%ri /... :, //-,%>'/. r;//, / /./ �i;/!i�r/j ;Mi:r �;.:•;%fir///// �.. ,r, i /'' .//,i rrj/r.r., '/ r ' ri/�Q j//r ':/7r' .rr i / :/ .;r r �'z!l�, ... �:"r/ if rr/i:,i/i,!i/„��;/ii i, i„ �,':i r/i,ii!!: 9 r%.%., i, r/ // - ! / �,?/,/�G%:ri ii;,/:.//..,i. ✓: r/ .r/.� o,L%i i/ /%; ii'0 L60 L 111' ;-.". 2 L L 37 10781: 89 6006 L60110 SECURITY FEATURES:MICRO PRINT TOP&BOTTOM BORDERS-COLORED PATTERN-ARTIFICIAL WATERMARK ON REVERSE SIDE-MISSING FEATURE INDICATES A COPY TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parce - Permit# 1 �� �� IW Health Division ��"" . i f�+ Date Issued I 0J Conservation Division?—'g > /0�. InA, C� �s Fee Tax Collector � /al — �.y ��� � � ' Application Fee Treasurer Planning Dept. Checked in By, ti Date Definitive Plan Approved b an Board ���® Approved By Historic-OKH Prese Project Street Address Village. (�OHA a Owner 10.t6 ( Clio624A s Wald Telephone n0i Q 2 _SUB WaRk 4)t4j1V D® "if M yek Permit Request 614 L44A J, 9" obck7l W-.41ev Square feet: 1st floor: existing proposed 2nd floor: existing -ZA06 proposed Total new 16 000,ZD Valuation27 0 Zoning Distr• Flood Plain Groundwater Overlay Construction Type 0 Lot Size�[ Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: es ❑No On Old King's Highway: ❑Yes Basement Type: ❑Full 41crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) / Basement Unfinished Area(sq.ft) ;?.,fla Number of Baths: Full: existi g ' new Half:existing new Number of Bedrooms: existing newJ� Total Room Count(not including baths): existing I I & new First Floor Room Count �I Heat Type and Fuel: ❑Gas Oil ❑ Electric ❑Other Central Air: ❑Yes /0�0 Fireplaces: Existing T— New Existing wood/coal stove: 0les ❑ No Detached garage: ❑existing ❑new size Pool: ❑existing ❑ ew size Barn existing ❑new size Attached garage:Cl existing ❑new size Shed: xisting ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded Cl Commercial ❑Yes 4<0 If yes,site plan review# Current Use� �{, � Proposed Use - / BUILDER INFORMATION Name tls �CN olr� Telephone Number Address_/Jj �> C Gt.�✓1 ��'' License# Home Improvement Contractor# Worker's Compensation# _T ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE 6 i FOR OFFICIAL USE ONLY t � PERMIT NO. - DATE ISSUED MAP/PARCEL NO. _ ADDRESS ; •_ VILLAGE ! OWNER - DATE OF INSPECTION: FOUNDATION 9�Sn.w O c d�ll5i��j_ i �. FRAME j _ - ` ,• t ::moo - _ . -, ' INSULATION � - FIREPLACE ELECTRICAL: ROUGH FINAL r 4 PLUMBING: ROUGH FINAL _ GAS: ROUGH FINAL-: - FINAL BUILDING f DATE CLOSED OUT }' ASSOCIATION PLAN NO. � I <-N 1 ne."mmonweattn of massacnuseus Department oflndustiial Accidents Office of Investigations` . 600 Washington Street y,: Boston,MA 02111 www.mas&gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Apulicant Information Please Print Legibly Name (Busmess/organma' nRndividual ' � Address: City/State/Zip: ju ` 0�3S Phone#: Are you an employer? Check the appropriate box:. Type of project(required): 1.❑ I am a employer with - 4. El am a general contractor and I employees (full and/or part-time).* have hired the sub-contractors 6• ❑ New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet $ 7. ❑ Remodeling ship and have no employees These sub-contractors have 8. [] Demolition working for me in any capacity. workers' comp. insurance. 9• E] Building addition i ? [No workers' comp. insurance 5. ❑ We are a corporation and its req ' ed.] officers have exercised their 10.0 Electrical repairs or.additions 3. a homeowner doing all work right of exemption per MGL 11.0 Plumbing repairs or additions mys If.-[No workers' comp. c. 152,§1(4),and we have no 12.0 Roof repairs insurance required.] t 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: .F t Homeowners.who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such IContractors that check this box must attached an additional sheet showing the name of the sub contractors and their workers'comp.policy information. _ I am an employer that is providing workers'compensation insurance for my employees"Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: 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 maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certi under tl ins and penalties of perjury that the information provided above is true and correct Si afar . Date:. Phone#: o� Official use only. Do not write in this area,to be completed by city or town official City or Town:, Permit/License# LLIBo,"ard g Authority(circle one): of Health 2.BuildingDepartment 3.City/Town Clerk 4..Electrical Inspector 5.Plumbing Inspector her act 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 o€hire, express or implied,oral or written." An employer is defined"A'an iridividnal part cqhip�:association,Forporation 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. Howev.,er:tlte 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 bean 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 Tiert nor any commonwealth y 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 t the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if. Please fill ou necessary,supply sub-contractor(s)name(s),address(es) and phone number(s)along with their certificate(s)of ne PP . �' employees other than the insurance. Limited Liability Companies(L,LC)or Limited Liability Partnerships(LLP)with no employ . 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 indust rial Ac cidents. 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 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-1i6enses..A new affidavit m►rstbe 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 T y Office of jnvestigations . r. 600 Washington Street� . Boston,MA 02111 f Tel.#617-727-4900 ext 406 or l-877-MASSAFE Fax#617-7274749 Revised 5-26705 www.mass.gov/dia Town of Barnstable °^ Regulatory Services Thomas F.Geiler,Director 0r�. ,ra 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. / O /�' Type of Work: .� Estimated Cost Address of Work: f ///�&IN cktl Owner'sName:,sl Sa"n �C�o>f :') Date of Application: 0/>a �Y' I hereby certify that: Registration is not required for the following reason(s): FWork excluded by law OJob Under$1,000 Building not owner-occupied caner 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. 6 d Date Owner's Name Q:forms1omeaffidav RESIDENTIAL BUILDING PERMIT FEES APPLICATION FEE New Buildings $100.00 Residential Addition $50.00 Alterations/Renovations $50.00 Change of Contractor/Builder $25.0.0 FEE VALUE WORKSHEET NEW LIVING SPACE _square feet x$96/sq,foot= x.0041= plus from below(if applicable) ALTERATIONS/RENOVATIONS OF EXISTING SPACE square feet x$64/sq,foot= Z/)?-0x.0041= plus from below(if applicable) . QARAGES-(attached&detached) squaze feet x$32/sq.ft.= x.0041= ACCESSORY STRUCTURE>120 sq.ft. >120 sf-500 sf $35.00 >500 sf-750 sf 50,00 >750 sf- 1000 sf 75.00 >1000 sf- 1500 sf 100.00 >1500 sf-Same as new building permit: square feet x$96/sq,foot= x.0041= STAND ALONE PERMITS Open Porch x$30,00= (number) Deck _x$30.00= -3 0'0 0 (number) Fireplace/Chimney x$25.00= (number) Inground Swimming Pool $60.00 Above Ground Swimming Pool $25.00 Relocation/Moving $150.00 (plus above if applicable) Permit Fee- Projc= R�.,nFanna i M Town of Barnstable P� o Regulatory Services Thomas F.Geller,Director I Building Division lec;�y Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.townb arnstable-ma-us Fax: 508-790-6230 Tice: 508-862-4038 HOMEOWNER LICENSE EXEMPTION Please Print j DATE l0. 70B IACATION 3 f l� Cil h e village number street "HOMEOWNER": , home phone ifwork pbone# name p CURRENT MAM NG ADDRESS: _ZI )n�.7 J_�_ G 4 O't 4 Dd-�v3 city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellines 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 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 respo a for all such work performed under the building permit. (Section 109.1.1) sumes responsibility for compliance with the State.Building Code and other The undersigned"homeowner"as applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Bamstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and re ts. Signature of Homeowner Approval of Btuidin9 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 Mates that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this sec6cm(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,tbafsuch Homeovmer shall act as supervisor:' Many homeowners who use this exemption are unaware that they are assurrnng the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.1� 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 itwould 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 corrurnrnities 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 formlcertification for use in your community. 780 CMR: STATE BOARD OF BUILDING REGULATIONS AND.STANDARDS _ ENERGY CONSERVATION FOR NEW CONSTRUCTION LOW-RISE RESIDENTIAL BUILIbmS BAR' rt SLE Manual Trade-Off Worksheet 2QQ � PH 12: 4 Pernut# UGh�'1 10 D `o uilder Name Date �h BB� 1 ' udder�dddress ai y1 :< P _-._.(�. ,�� ... -.. .....__ FS-iie Address Submitted By Phone �U - a f'Qc;� PROPOSED REQUIRED Ceilings SUDghts,and Floors Over Outside Air i. Required Insulation x Net Area U-Value Description R-Value U-Value = UA (Table J6.2.2h) x Area = UA Ceiling —4fL-) o 0�� �z1 ftz 2, O I c 0 I �s ) 19 C5 (Table J6.2.2a) Floor Over Outside Air ftz (Table J6 2 2a) e5 7 _ .._.._. t.s ? Total Area ft2 k � � Walls,Windows,and Doors _--- __........... ... _..__.-_—._....._Insulation z Net Area Required Description R-Value U Value = UA U-Value x Area = UA Walls '7 z T q ,.., able J6:2.2b,c,d) 3 v�� l !�ft 2 Windows — r �J (,1 ftz , (NFRC or Table JI.5.3a) J j Doors — . �3 `fM112 (NFRC or Table J1.5.3b) Sliding Glass Doors — ftz (NFRC or Table J1.5.3a) ftz ` Total Area Floors and Foundations Insulation Insulation R- x Area or Required Description Depth Value U-Value Perimeter =UA U-Value x Area =UA Floor Over Unconditioned (Table J6.2.2e) ftz Space 1/19/01 780 CMR- Sixth Edition 760.37 . 780 CMR:, STATE BOARD OF BUILDING REGULATIONS AND STANDARDS THE MASSACHUSETTS STATE BUILDING CODE Basement Wall (Table J6.2.20 ft2 Unheated Slab $ (Table J6.2.2g) in. Heated Slab ft (Table J6.2.2g) in. ftZ ftZ Total Proposed UA must be less Total A5 Total than or equal to Total(or Adjusted)Required UA Proposed UA P OR Required UA Statement of Compliance:The proposed building design represented in A5 Adjusted these documents is consistent with the building plans,specifications, Required UA and other calculations submitted with the permit application. Builder/Designer Company Name Date c 760.38 780 CMR- Sixth Edition 1/19/01 W ------------- d.,.,v ;., z j ell i • LOMANCO 600 ROOF LOUVER-BLACK 2 X RIDGE BOARD M 2 X 4 RAFTER TIES @ a ALL NEW RAFTERS FBI R-30 INSULATION - ®.� +r, W/1 1/2 AIRSPACE L, LINE OF IX.2 X 4 RAFTERS fps rF� 4"T-111 SHEATHING TRAY CLING. ® BTW RAFTERS F+~ 1� 21 SIMPSON STRONG TIE �\ O "RR"MTL RAFTERS 2%B EXPOSE D COLLAR TIES•ALT.RAFTERS _lam Y m Q�� w%O 1 X TRIM BTW RAFTERS 1/2"DRYWALL O •q t7 R-13 INSULATION _ F,"i •y iy TT-�i 2 X 6 WALL W IX 2 X 4 WALL BEYOND V A n m 0 - R-19 INSULATION rT, V NEW EX CLOSET BARN 2 X 8 PI RIM BD. BLDG SECTION 2Xe F OII� Q 2 R-30 INSULATION M A3 Scale: 1/4" = 1'-0" ROOF ASSEMBLY: 30 YR ARCHITECTURAL SHINGLES TO MATCH IX. 15#BLDG PAPER - - [...F 5/8/CDX SHEATHING W/"H"CLIPS . .2 X RIDGE BD llF• 2 X 8 @ 16"O.C. CONTINUOUS RIDGE VENT R-30 INSULATION - rT, 2 X 4 COLLAR TIES it •• W 1/2"DRYWALL CLNG. II� NEW 2 X 4 SIDE WALL TO SUPPORT NEW �.� Gw• MTL DRIP EDGE PITCHED ROOF T. R1• 17-f� ALUM GUTTER R-19 INSULATION - O W/eLOaaRG TO OS - 5/8 SHEATHING Z n TYVEC BUILDING PAPER CEDAR SHINGLES / 1•y �� x FASCIA eo I O SEE EAVE DETAIL ABOVE "y�j Cd RUOUSsoFFITVENT IX.BREEZEWAY(SEE PLAN) 4 x s RUFg aO IX FLR&PARTIAL SIDEWALLS - ra.• rq O FF TO T.O.Si DETAIL AT SAVE IX STONE STOOP NEW DECK - y SCALE 1"=1'-0" [�� T. TO GRADE NEW 2 X LEDGER A31 • W/1R DIA STAGGERED LAG BOLTS EVERY 6" I I I I 1 BLDG SECTION u A3 Scale: 1/4" = 1'-0" f 912a1b Is e7v- '��►+� Town of Barnstable *Permit# 9 0 Erptrm ',W from Issue tic s Regulatory Services Fee %63 Thomas F.Gellert Director m Building Division Tom Perry, Building Commissioner 200 Main Street,.Hyannis,MA 02601 PERMIT Office: 508-8624038 Fax: 508-790-6230 SEP 19 2605 EXPRESS P]ERAM APPLICATION - RESIDENU&kQ x Jam►NotYaalidwithoutitaxPtessimprint F SARNS'q®L LP/parcel Number 0© 1 00 h f � . � Dperty Address S, . m Residential Value of work ' l ��Minimum fee of•$25.00 for work under$6000.00 yner's Name&Address )ntractQr_s_Name .epja �21:W4Telephone.Number - _ — ome Improvement Contractor Licens #(if applicable) onstruction..Supervisor's License#(if applicable}. WorA's Compensation Insurance Check one: •. I am a sole proprietor I am the Homeowner ❑ I have Worker's Compensation Insurance xuraace Company Name Torkman's Cdntg.Policy# 'opy of Insurance Compliance Certificate must be on file. ermit Request(check box) ❑ 1U roof(stripping old shingles) All construction debris will be taken to ❑Re roof(not stripping. Going over existing layers of roof) XRe-sido' 5 _ 14 Replacement windows. U Value , `1 (maximum.44) *Where required Issuance of this permit does not exempt compliance with other tows deem tzneat regulations,i.e:Historic,Censervatiem,etc. ***Note: Property Owner crust sign Property Owner Letter of Permission, Qm�e ovement Contractors License is required. 3igtrature 2:Forms:expmtrg Revise063004 ; The Commonwealth of Massachusetts Department of fridustkal Accidents ' Office of Investigations ' : 600 Washington Street Boston,MA 02111' UV www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/ElectricianslPluinbers Applicant Information Please Print Legibly Name (gu s/Orgamzation/Individual)' ��? i Address: City/ : � Y� l O� Phone#: State7Zip Are you an employer? Check the•appropriate box-.. Type of project(required): 1.M jam.a employer with 4. ❑ I am a general contractor and I 6,_❑New construction employees (full and/or part-time).* have hired the sub-contractors 7 Remodeling 2. I am a sole proprietor or pargner- listed*on the attached sheet I andhave no employees These subcontractors have •8. �❑ Demolition sbip workers' comp.insurance. 9• ❑ Bu$ding addition working for mein any*capacity. [No workeW comrrp.insurance 5. ❑ We are a corporation and its mp officers have exercised their 10.❑ Electrical airs or.additions required.] t of ex lion er MGL 1'1.❑ Plnnibing repairs or additions 3 I am a homeowner doitrg all work . c. 2,§1(4),d we have no 12.❑ Roof repairs r� \myself [No workerst comp employees.(No workers- insurance required.] 13:❑ Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information '4 t Homeowners who submitthis affidavit indicating they ate doing all-work and theubi m outside contractors must submit a new affidavit indica3itng such tContract= that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'carmp:policr won I am an employer that is providing workers'compensation insurance for my employees.'Below is the policy and job site,' information. f Insurance.Company Name: .h 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 call lead to the imposition of criminalpenalties 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 afine of .p to$250.00 a day againstthe violator. Be advisedthat a copy of this statement may a forwarded to.the Office of . Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information proviaea as ve is true and curre;c� Date:• Si atmre: Phone#: Official use only. Do not write in this area,to be completed by city,or town official City or Town: PermhUcense# Issuing Authority(turtle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector 6.Other Contact Person: Phone#: mation and Instructions ; Infor , efts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Massachus person in.the service of another under any contract o€hire, pursuant to this statute, an employee is defined as"..,every express or implied,dral or written." :• ;' ers association, corporation or other legal entity,or any two or more "an divi nal,,pa u *,- ' An employer is defined aS'::. d 10 er,or the of the foregoing engaged in a joint enterprise, anal incjaing the legal representatives of a deceased emp Y association or other legal entity, employing employees. Hovteve:r:tl e receiver or trustee of an individual,partnership, antof the owner of a dwelling house having not mole tan do maintenance, apartmentseanwns uc�tion or repair woik-on such dwelling house dwelling house of another whoemp y$persons or on the grounds or binding appurtenant thereto.shall not because of such employment be deemed to be an employer." MGL chapter 152, §25 CC6)also states that"every.state or local licensing agency shall withhold the issuance or. enewal of a license or pew to operate a business or to construct buildings in the commonwealth for any r produced acceptable evidence-of compliance with the insurance coverage required." applicant who has not p ter 152, 25C states"Neither flee commonwealth nor any of its'political subdivisions shall Additionally,MGL chap . § (� enter into any contract for the performance of public work untilacceptable'evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants . • . f Please completely,by checlting the boxes that apply to Your situation and,i fill out the workers' compensation affidavit` necessary,supply sub-contractors)name(s),addresses)and phone numbers) along with.their certifieate(s)of ve insur ante. Limited Liability Companies(LLC)or Limited Liab>lity Partnerships(L•LP)with no employees other thaw the rkers members or partners; are notrequir advised th t6 carry at affidavit maybe submitted to the Department f Indudoes astrial employees,a,policy is required. B.e 1he affidavit Accidents for confirmation of insurance coverage.. smoebee t or licensee to sip es being requested, not the Deparfineat of should. be returned to the city or town that the application f p Industrial Accidents. Should you have any questions regarding the law or if you are required to-6btain$warkers' co ensatioupolicy,please call the Department at the number listed below.. Self-insured companies should entertheir z� self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Departmentprovided aspace at the he bottom of the affidavit for you to fill out in the event the Office of Investigations has to u Y g applicant Please be sure to fill in the permlt1hcens a number which will be used as a reference number. In addition, an that most submit multiple permit/license applications in any given Year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"*the applicant should write"all locations in (city or "A co of the•affidavit that has been officially stamped or marked by the city or town may be provided to the town). copy applicant as proof that.a valid affidavit is-on 1110 for:fine or�itp.o -h6ennott es.. to anew affid ess b�erci'al venture year,Where a home owner or citizen zs obtaining a h P (ie. a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. lions would bike to thank you in advance for your cooperation and should you have any questions, The Office oflnvestiga please do not hesitate to give us a call. The Departments address,telephone and.faxnumber: The Commonwealth of Massachusetts . Department of Industrial. Accidents Office Q;f Investigations .600 Washington$treet V BOAMI MA.02.111.. Tel.#617-7-27-4900 ext 40.6 or 1-877-MASSAT'E Fax#617-727-7749 Revised 5.26.0 www,mass.gov/din Town of Barnstable Regulatory Services snxxsr+BUP. Thomas F.Geiler,Director Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-403 8 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder as Owner of the subject property hereby authorize to act on my behalf; in allmafters relative to work authorized by this building permit application for: (Address of Job) Signature of Owner Date Print Name QTORMS:OVINERPERMISSION 90L FND. I CERTIFY THAT THIS PLAN HAS BEEN PREPARED IN CONFORMITY WITH ��• THE RULES AND REGULATIONS OF THE > REGISTERS OF DEEDS, ,... !rl N a t- M& R.L.S. o a co Q s� J Ln cW MASHPEE BARNSTABLE Z � ' to LOCUS MAP - a a ' �- SCALE 1 1 25,000 v o ASSESSORS z MAP 9 PARCEL 9 GRAPHIC SCALE ZONE 0 30 60 120 A.P. NEW RESIDENCE F POST FND. 2.37' BACK OF 3 STREET w C.B. - At7 • � m . . ' 2 v J CB Sg•26, ET m a FND. Z O'07'15„ E � a. N 8 ,i Ln �. �r RRY 226.77 C.B. �RENE G• pp,GE »1g9 E FND. -� BOOK 1317 ' N79 27'31 POST OFF 00.1 FEN N 8 LINES DWELLING p.03'38 E POST �cp. 413,94! cr. �-- — 5p2't C.B. FND. WTI 96 OFF N . C.B. 156,554 t S.F. UPLAND C.Bo,� 0'29 '54'34 W SET 1,906 sq. ft. WETLAND FND.• C.B. 3.64 cr �:t AC. TOTAL SET. 1�+ O 377.08 0.62' 04 W I.P. `Jos cb 10.20 S84 02' FND. 64.69� O. 0.62' LP'; I•P• I.P. BACK OF o� FND. FND.FND. STREET 622.53' p C.B. S840261021#W SET — 69 t _ MARTHA C. TRACEY BOOK 7597 PAGE 313 i PLAN OF LAND IN ( SANTUIT ) BAR N STAS LE MASS, FOR PRESTON A. & MABEL WRIGHT I . HEREBY CERTIFY THAT THE PROPERTY SCALE: 1" = 60' DATE: NOV. 06,1992 LINES SHOWN' HEREON ARE THE LINES DIVIDING -EXISTING OWNERSHIPS, AND THE LINES OF THE BAXTER & NYE INC. STREETS AND WAYS SHOWN ARE THOSE OF REGISTERED LAND SURVEYORS PUBLIC OR .PRIVATE STREETS OR WAYS ALREAbY skiff ; CIVIL ENGINEERS ESTABLISHED AND THAT NO NEW LINES FOR OSTERVILLE, MASS. DIVISION OF EXISTING OWNERSHIP OR FOR NEW WAYS ARE SHOWN. DATEi t l . . oftVjtA.CA DEED REFERENCE: BOOK 2250 PAGE 349 #92154 Page 9 Lot 9 SAIJrSTOLE./* TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO . TYPE OF CONSTRUCTION .July...28.,19..72. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information; Location Street Santult,Ma, Proposed Use BH?:^-stora^ Zoning District Fire District .....Cotult Name of Owner Address ..teta.Stxeet Nome of BuilderJ^9S®T.?...&..Address ...Pa... Name of Architect Address Number of Rooms ?:Foundation .....Q.9.??.cpete ..pierS Exlerior Roofing ..Asphalt Floors Interior Heating ^9^®Plumbing Fireplace Approximate Cost il:.f.P.9.9..*..9.9. Definitive Plan Approved by Planning Board 19 Diagram of Lot and Building with Dimensions /O SUBJECT TO APPROVAL OF BOARD OF HEALTH O cr;2^m i1 q:u^ rs cr U7 to CO u [- LU h"Q l9o TownIherebyagreeto conform to construction. Name' ran /fe yfe r/?A](re / regarding tbe above V^^ight,Preston A. 15310 No Permit for roof '31 Locotion I'kin Street replace barn Owner frameType of Construction Plot Lot Permit Granted 19 7^ Dote of Inspection 19 Dote Completed 5.3....19 PERMIT REFUSED 19 Approved 19