Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
0015 OLD SHORE ROAD
l Application Number....'."...' ,,. Section 5—Detail Cost of Proposed Construction S<O, 000.— Square Footage of Project-, 4, . Age of Structure Dig Safe Number # Of Bedrooms Existing Total# Of Bedrooms (proposed) 110 MPH Wind Zone Compliance Method ❑ MA Checklist ❑_WFCM-Checklist ❑ Design _ Section 6—Project Specifics ❑ Wiring Oil Tank Storage ❑ Smoke Detectors ❑ Plumbing ❑ Gas ❑ Fire Suppression ❑ Heating System ❑I Masonry Chimney ❑ Add/relocate bedroom Water Supply ❑ Public ❑ Private Sewage Disposal ❑ Municipal ❑ On Site Historic District ❑ Hyannis Historic District ❑ Old Kings Highway Debris Disposal Facility: I am using a crane El Yes ❑ No Section 7 Flood Zone Flood Zone Designation Within or adjacent to a wetland, coastal bank? Yes ❑ No ❑ Section 8 —Zoning Information Zoning District Proposed Use Lot Area Sq.Ft. Total Frontage Percentage of Lot Coverage #of Dwelling Units (on site) Setbacks Front Yard Required Proposed Rear Yard Required Proposed Uh gam. Side Yard Required Proposed 1~ f, Has this property had relief from the Zoning Board in the past? ❑ Yes ❑ No Last updated: 1/31/2020 CF tHE Tpy� x C�? BUILDING DEPT. Application Number.......A.� (J................../........'................... sARNASMS. , r Permit Fee.................................Zoning District........................ ���' AU-612 t912J ArFO MA'S A TOWN OF BAhiVSTABLE Total Fee Paid............................................................... ...... TOWN OF BARNSTABLE ` Permit Approval by...... ..... ...................On....4 BUILDING PERMI �l. /� I.wAii 4Ni ca�(J Map.........0.36...............Parcel............................................. APPLICATION Section 1 Owner's Information and Project Location Project Address E 5- OL-6 S I}OQ.E ?,Okp Village CO`j L t. 1T Owners Name FAIL& I a T 14 A tJ�,( 0 D E WC-t Owners Legal Address t 5- 0 L-0 .5 40PI-6- izo#k City c o' (A-rF State (A PC Zip Owners Cell # :508 -7 VZ(' 0-7 6-7 E-mail �R Section 2 — Use of Structure Use Group ❑ Commercial Structure over 35,000 cubic feet ❑ Commercial Structure under 35,000 cubic feet ❑ Single/Two.Family Dwelling Section 3 —Type of Permit New Construction ❑ Move/Relocate ❑ Accessory Structure ❑ Change of use ❑ Demo/(entire structure) ❑ Finish Basement ❑ Family/Amnesty ❑ Fire Alarm Rebuild ❑ Deck Apartment ❑ Sprinkler System ❑ Addition ❑ Retaining wall ❑ Solar ❑ Renovation ❑ Pool ❑ Foundation Only Other—Specify Section 4 - Work Description ti l t D VJ 000 T— LhfAL' -3 f Last updated: 1/31/2020 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass gov1i a Workers' Compensation Insurance Affidavit:Bnlders/Contractors/Electricians/Plumbers Ayylicant Information Please Print Legibly Name(Business/Organizadon/Individual): Address: .1 -75TtA2 GfZ-r )&)� 04ZP✓& City/State/Zip: e(LV Il.L (fir 265s Phone#: See 9 - Z&/- -7 2 5' Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with- 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2 am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no-employees These sub-contractors have g, ❑Demolition workingfor me in an aci employees and have workers' Y capacity. 9. El Building addition [No workers'comp.insurance Comp.insurance.: required.] . 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions officers have exercised their 11. Plumb' repairs or additions 3.❑ I am a homeowner doing all work - ❑ � ep • m sel£ o wormers' right of exemption per MGL Y � comp. 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#I must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContnrctors 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 worker;'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees Below is thepolicy 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 D r insurance coverage verification. I do hereby certify u der a pains and penalties of perjury that the information provided above is true and correct Si store: Date v Lo Phone#: 'Sf7,g -Z'Ll -7 2/ Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Information 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 may 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 withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152,§25C(7)states"Neither the 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-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. . Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would bike 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 tf'tce of Investigations 600 Washington Street Boston,MA 02111 - Tel.#617-727-4900 ext 406 or 1-877-MASSAM Fax#617-727-7749 Revised 4-24-07 www:maw.gov/dia BYBTE.M g0F LE n "•71•• anw came car m nmR rt rmR r Am AAa m R R.n OA a>+�MhY'� lanr NO ��-. 1E nr ,.p.wr na Wr�uc~UF— AA \ IMAM L IArNIAI MIEI A[mae . +(n}•• Ilrarro NAM Lij a,�.(r rA1Enp1 AI01 aA LLMaa oa Imol •{•� ' L NrgAlll ML AMr a K 1/r rtn MA NAy NWNn taa r� 'I1T'• (xwr'�n uv "in• h w.nN a fiv �Lra NA rAreaL rrttilf wn � r uo v n 1S. nlrc n uauA A 1&�vn°iA,"M'c!Ij LZO'4b rnAn.rac .� • i w w f }P..m A s ME Awn A K IIAKr ow qr wwn earAr.a o.ueE ra CBay 5 k•, 7 m P Wit—�AA).ae rmr w 7X nct rne.n reuvwnen .. ��gpPoAuaxeAA��qq ra {+ �-it���, we �r.A cm w,uro.,��C.��exr nrxn o �Ao'Tf'"" nN. I� Y� L,A.rAAw I,w+t'pe Fnu o mwne',M A nA0 W a n.Y A ! L M[/A�rr jq��/gy�mo I'm 100y1G�I�ro.1�mev � r,�y I.A.A AAH aSc wrH r�SGIRSIOP1ro�i'A�r;e'dytl'tkSICKAAn 0.Y.Ir--[5�Smrw IANS— a �a nm�—n• nnro i1Aa RAH aae w7WY M!RX lr/H•J� r��.7n.. N.ANr Nr r wrou�t 4EwNAnO wa u AP SYSTEM DESIGN: CJ 11} t / �1 f °••Ho/� Nor m eesuc 0Ae0APC MOM re�,#.Gl1LA.Mf? � � ) �� r"\ ` (.r � ( ,(,•+..� ,."' ""p AI9065005 NAP 31 PANEL 74 0[Dn7 tteA,g o[onoow A Ito Eno.ae#EPP , I Q ",",�o7'pe:ti » �, ""1 \"'.^-• r f y�r. Ulf A U$000 e[AoN ISOw y�4' ' RC,,, ��• ... ��," —�...`•-� fFPNe/AN111#A9 en0(f).IJ70 RrnE TANn YR A t�,�k{i7. '� .•.. �•'. ..EI l� „�_ •��"W.• ~'�^r-, rl G IlAw G 4 .SQ� \.. .\ `\ I",. .h R-..L °`e.,�.•'.""�_ ' UACJWNh Sam .I.dQe+�it1L9!).t .71.r[eevo I\ i .�,.�..... .,,. „-.••s;^�.-._``"`..` e01f0Y�,•, a If.ef .fA1.Ir0 ErE '' `• � " .�/'• ~'•` A. 1�`��"~�'• TerAY,�_ for A.F. 4n7 ero. TOOT HOW LOOS Y1(111 Doe 0A(;1111100 CIIAW"A9(ACuB OR[DUAL) 1f ,l-''`� 1 �•-t-.- --.. �- ) SYaN59A Vie_.__ wiN A Oro Al Anoulle 1` 'i a� .,... •..�...� '4_.-,��-......,-..,r _ �,�.'•-.�„'•�"•'"'—`""'...•^••i-' `(1 r� wnuu5r-eAvlo 6pit m `':K;,'4'T" \ l "�.;.:^l•„",r.....�.1„"�''-`:...`�^^.-.� v'�\i - I / 0411, .,.1/io/Ie_ •�,._"•�J1"r`4'-`-^_—"••. -- _ A. e'�` ^p, MARK._s.J.kW'/lGlrM ` 1.... /^••:, ��`�°w�, \` pt/ 1 CMD 1 $01" PI Icy 067. AAA zv— WO FA D},YA \y_ f..JLf �'^•�^'f'm.`/'����/...��"��.. , Jl i 0.N, fug% t5 u 1er5 f/t turn fpto _ ye fml' IQ"Ve- /ES un � / � �. / f.er T/c )J,,.r� •�\ ww l `t 1 �` t� No oo7Aq' Ifo,' gytiY n J/1 N I ` 14 ouxowAtG WOOYUIrn[o 0 , TITLE 5 SITE PLAN or 15 OLD SHORE ROAD COTUIT, MA to PF19PARED/h l r _• ��.y J r:��., - - �,� �� ��, 5� .� `, l BORTOLOTTI CONSTRUCTION/ GRANT oarel MARCH A�2015' . ' l J "•�, f � � I 1' Beg11I•w ie' ...ear, A e ' �I^("/ryIILISdjDwn eap#017 lne, . -c i,,1, ) 0 fyN' •f•q.fY � ''S �' v 101nd auf��a `•>„•.� c s urdr awl r nn se! OCR y10-030 ..._.� .1'� ^ oA*5 oAnu A.aAu or ,r,L,v.0 rAPwautNnonr,.. orofa H•au rwo-[ANu.ra Application Number........................................... Section 9— Construction Supervisor Name Telephone Number O p ZZI - `7Z 1 Address 13`1 5;mCG(Z40" O&ty 05-M OILLCState 12n lk Zip 026SS License Number CS-yZ 56-1.3 License Type CS L Expiration Date 9 t'7- /2- I Contractors Email �.�L GZ�G�n 1 tr _Ca rvi. Cell# ' 07 -ZZI -7 21 s 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 b 80 R an a Town of Barnstable.Attach a copy of your license. Signature Date 3// 0 j Z y Section 10 —Home Improvement Contractor f Name E9 Lkc"y Telephone Number 019 Z21 7 21 Address h'�-j SILt a&4,fVe City O_5TL�i LVlLL&_ State_p✓I dt Zip DZ(.fj<_ Registration Number (35 g/6 Expiration Date Z) 2 S/ 22 I understand my responsibilities under the rules and regulations for Home Improvement Contractors in accordance with 780 CMR the Massachusetts Sta ilding Code. I understand the construction inspection procedures,specific inspections and_ documentation required b) 780 MR an he Town of Barnstable.Attach a copy of your H.I.C... Signature Date Section 11 —Home Owners License Exemption Home Owners 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 SIGNATURE Signature Date v z v Print Name &9molv17 1j , LACE ,lL Telephone Number ,)d$ ZZI -7?i < E-mail permit to: 6D f}C�y1�z�_�Y rn/k i t Coyl1 Last updated: 1/31/2020 Section 12 — Department Sign-Offs j Health Department ❑ Zoning Board (if required) I Historic District ❑ Site Plan Review(if required) ❑ Fire Department ❑ y Conservation ❑ For commercial work,please take your plans directly to the fire department for approval Section 13 — Owner's Authorization _ as Owner of the subject property hereby authorize C® L Ptr—E!J to act on my behalf, in all matters relative to work authorized by this building permit application for: l 5 a I�! SG1 rrt� .5 (Address of job) Signature of O her date L ?1-�r 4-t P Print Name Last updated: 1/31/2020 Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees, Pursuantto this statute,an errcpfoyee 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 Iocal licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to constrict buildings in`the commonw aith for atzy applicant who has not produced acceptable evidence of compliance with the insurance_.coverage requ.ired.- Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealtE nor any of its political aibdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance - require-ments of this chapter have been presented to the contracting authority.- Applicants f�, Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-coatractor(s)mme(s), address(es)and phone number(s)along with their cel. rcate(s)of insurance. Limited Liability Companies(LLC) or Limited Liability Partnerships(LLP)with no ei,.rloyees 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 gent or Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. TZie ar{davit should be returned to the city or town that the application for the permit or license is being requested,not the Deparsnent 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 he appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at th.e 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 add i don,an applicant that must submit multiple permitllicense 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 mast be filled out each year,Where a home owner or citized 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 'he Department's address,telephone and fax number: ' The Commonwealth of Massachusetts " Depar4ment of 7ndusliak Accidents% i 1V office of%vestiptia zs 600 Washington Stet Boston,NTA02111 Tet.A 617-727-49GO ext 406 or 1-977-MASWE IZevi:sed 4-24 07 Fax#617-727-7749 www.mass gov1dia � � r The Commontwalth of Uassachusefts Department offtxdmsftialAccidents O, ca o,f invesfigadons s 600 Washington meet Boston,ALI 02111 wwmrriass�gaw'dia Worket-s' Compensation Insurance Affidavit:Builders(Contractors/El_ec-triciansMumbers Appl cant Infarmation Please Print Legibly Name(Ba�Organizafion/f ldividliaq_ 60 (,A-C—f5 ' Address_ 1_3 STD 6Z 10 fit: y2 t City/State/Zip: p5-j C0I LL&- k 0246 1�-Phons g: v S zz c -l z.i 5 Are you an employer?Check the appropriate:box: TJW of project(req-ire,4: L❑ I am a employer with 4. ❑ I arse a goal contractor and I 6- ❑New constaucfioa employees{full and/or part-time)* have fired the sub-contractors. 2_'[ I am a sole proprieetor or partner Listed on the attached sheet 7_ ❑Remodeling ship avid have no employees These sub-contractors have g- ❑Demolition wodcing for me many capacity employees and have workers' 9_ ❑Budding addition [No workess' comp_insurance comp-msurance-I 5- ❑ We area corporation and its 14-❑Electrical repairs or additions I❑ I am a homao'wner doing all work officers have exercised their I I_.❑Plumbing repairs or-additions myself [No works rs'comp- right of exemption per MGL 12-.❑Roof repairs insurance required_j I c- 152,§1(4) and we have no employees_[No workers' 1 -❑Other comp-insurance required..-]; *limy apptiout tbat checks boa-#1 must also fill out th¢section below showing rhea woAEn'compensafiGn policg infurn=dMl. �Homeawners who submit ibis afhdx=indkxting they are doing all wotic amd rhea hire outside contractors must submit anew affidavit irldirAtina mcli IConbmcturs thst check this box must sttached an additional sheet showing the name of the mb-caaft3ct s and state whether ar not those ensues have avlayees. If the sob--contractors have emnployee%they must provide their wart ers'romp.policy number. I am an employer drat is proidzb erg nrorkers'campensadon inviranceforaty employees Below is Ste po&cy artd job site informafi tn. Insurance Company Name: Policy P,or Self-ins_Lim : ExpirationBate: Job Site Address: City/StateJZip: Attach.a copy of the workers'compensation policy declaration page(shoNving the policy number And expiration date). Failuree to secure coverage as requiredunder Section.25A of MGL c. 152 can lead to the imposition of"crim nal penalties of a fine up to S 1,5D6.©a and/or one-year imprisonment,as well as civil penalties in the.fcxm 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 Imestigations of tfle DIAAA fvr insurance coverage ve ifs ation- I do{iRreb�,C-erf- Tin tkepains and penalties ofperjury titatffte informatian prot¢ded above is true and correct Simatum- Bate: Phone#: Off ctai use on[y. Ida not wrifg in fills area,to be completed by ciV or town official- City or Town:. Permit/License# Issuing Authority(tarcIe one): 1.Board of Health ?.Building Department 3.CitylTown Clerk 4.Electrical Inspector S.Plumbing inspector 6.Other Contact Person: Phone 9- 6 Town of-13-arnstable ` Regulatory Services ��aF ce+e roiyti Richard V.Scali,Director Building Division xAxxsrnsiE Tom Perry,Building Commissioner 1 9-- ��� 200 Main Street, Hyannis,MA 02601 prfD � www.town.barnstable.ma.us Office: 508-862-403 8 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: ti JOB LOCATION: number street village name home phone# work phone CURRENT MAILING ADDRESS: _. city/town state zip rode The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as su ep rvisor_ DEFINITION OFHOMEOWNER -- Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or,istri^nded to be, a one or two- family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Suchl`_homeowner"4shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible-for all sucli work performed under the building permit. (Section .109.1.1) The undersigned"bomeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. - The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official t r 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. . 1 HOMEOWNER'S EXEMPTION *" The Code states that: "Any homeowner performing work for which a building permit-is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors); provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q,RuIes &Regulations for Licensing Construction Supervisors,Section 2.15)'4This lack of awareness often results in serious problems, particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities, many communities require as part of the permit application,that the homeowner certify that he/she understands the responsibilities iof 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 forrn/certification for use in your community. Q:\WPFILES\FORMS\building permit forms\EXPRESS_doc Revised 061313 �1HE rti Town of Barnstable Regulatory Services x + BARNSTAB + + + KAS& E x Richard V.Scali,Director iOrf039. a Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I, 13 al-al-14 O 0&-yVC-% , as Owner of the subject property hereby authorize t D LAc.&y s(>_ to act on my behalf, in all matters relative to work authorized by this building permit application for. / 5 bLO 51+c)(L6 2vA-a Co j A 1 f Address of Job) Pool fences and alarms are the responsibility of the applicant. Pools are not to be filled or utilized before fence is installed and all final inspections are performed and accepted. signature of Signature of Applicant FeT pf !>' D a/G E I-ACL`� Print Name Print Name Date Q:FORMS:OWNTERPERMISSIONTTP0OLS ' TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Ma Parcel ® Application # Health Division � �/� Date Issued b8y .. _ Conservation Division -0169? ON o e 61- ti10 Applicatie Planning Dept. , Permit Fee Date Definitive Plan Approved by Planning Board "Wo1i^ .r f Historic - OKH _ Preservation/ Hyannis Project Street Address 1-45 ® L f) S ft0 fZ, Village CODA t T- Owner oe,,F4 Address l OL0 S KOP-l% P . Telephone q Permit Request P6-V kt-klc, 0W NND AAL>r l3 "C, °�ZtPd�tlZ.j tZ PL6�� fLo'(1 v./-001 - 5 tLLS 1 f--t_vo2 7Tok5't N `-hwNDR-�-/ Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation erg` Construction Type 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: ❑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 ❑Yes ❑ No If yes, site plan review # Current Use Proposed Use -- — APPLICANT INFORMATION - (BUILDER OR HOMEOWNER) Name Ly 1-t2-,4 Telephone Number s G-6 � I Address . l 3 7 5Tu 2-ti Xt.D 6,e-' D 1Z-1 Ud License # e 5 d 7 S 157 3 dStfZ�I�U.� o M OZ6 S' Horne Improvement Contractor# Email Worker's Compensation # ' ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE 1� , i FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED> / MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: r= FOUNDATION FRAMEL 1 1 t INSULATION ! FIREPLACE ELECTRICAL: ROUGH FINAL ` PLUMBING: ROUGH FINAL GAS: ROUGH Y FINAL FINAL BUILDINq,�&)hh-b DATE CLOSED OUT ASSOCIATION PLAN NO. ',6 LEGEND SYSTEM PnROFILE''`. . �:�MM�e�N cY NOTES $ M�NR aM ram ; :a aINRA D �o�,u D, m eay 2 GUNDRD �^�, OR ` Rry/2 SEP C TANK-� BOx �IB9� fAVMIY , , w aoxwm wo •. �w lrux 3 x]� - ' An AND LOCUS MAP NOT TO SCALE SYSTEM DESIGN �' ;` ti` y i °^"'CAM^K a. B. ASSESSORS MAP Js PARCE,T. GARBAGE DISPOSER S NOT U--D x ' DESGN ROW 6 BED IIO Gvp.B80 GPD [Tt/ A�� uK A 51513GP E ON FLOW /� �/`I /'n V•\� \� '. l \ r G A . SEPTIC TANK 0'(2)7—0 7 - - `\.B f' •�l�'�-�~�`��-�'�'_ �-/ SE A 15"c[:KPTIC TANK s r Y SIDES: 2(SO5 2BJ)2()I BB CPO R oM sos 12-(.74) 479,GPp s \ "� �\� TES T'HOLE LOGS -~ , OTAL BDI S.I. 667 GPD _ .4 .: ,CB �FCh79 - 9 MO I �� _ ENGINEER:DPN EL E.WNSAlvES.SE/1JSBT / USTM(S)S00 STONE' LG�NDG[NA BEflS(ACME OR EOUAI), l • t \ C �.���—� - OAVID STANTON,NS' < A 3 \�� M U. "�` WITNESS , on I• _i _ DATE: / /IB _ t1 •�'1 /�' ERCRATE. <2 - /INCH x ,- .ti ' -, A 4 \ �`` L_/ ^^ \- 6_\� � � "�' . •1� CUSS_60115 P/. 19952 PR— DATE• OARO OF HEALTH MA x - \v - \ \ J o 1 • +. ELEV EIfV. ' a 1TM 1 US • •, Y 1. \ r \ OrR J/2 1—3/2 ig / 20 O I \ \ ' 1 A/6 J2.]. 22- 1IR 4/6 - J2.2' r 6 ry \\ EL40 M/G]z- BJ12.SY 2/<120"' 120' 24.0' ^ NO OR...DWATE R ENCOUNTERED TITLE . 5 SITE PLAN '&.• / ��\ice /. /� \ �, OF 15 OLD SHORE ROAD {`�✓�q. I ` s"`°I \�1 \ COTUIT, MA PREPARED FOR '� � �,,�� Da `At `� ��• �• BORTOLOTTI CONSTRUCTION/ � r \ GRANT DATE: MARCH 4,2016- ✓�- �. \�/ram, t \��`.F' ��Ill ��bs[[1 i l ePwn'00 e innrinl,inr. ` r ,;�` �i;• 1�[9 /and 9u9ro1o�5 ��� ]xtJ• 3-,)-10 / ` V rww�Nou>HIPOwr uA oases DATE OA.IELtA.OJA P.E.P.LS. OCE«q I6-036 • � t x - A 4 tam TdWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel ' Application # Health Division Date Issued Conservation Division Application Fee 'Planning Dept. Permit Fee Date Definitive.Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address Village - CoTJ1� Owner , Address Telephone 29/—o?V--86134 Permit Request 51AI S-kr ig j�1M)Dh>ra+P, �t/,Tl� �►�eu/ �,� J;►>�L-t�,�,v��/ � . �J1/�urAY S�B2 f�/��i Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District / Flood Plain Groundwater Overlay Project Valuation b 0 .Ob Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family (# units) Age of Existing Structure /SO Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ,X No Basement Type: )d Full ❑Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new f: existing new Number of Bedrooms: existing _new �i Total Room Count (not including baths): existing ®rT �C Fiftloor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New s,� Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑existing ❑ new size—Pool: ❑existing ❑ new si d,<, Barn: ❑ existing ❑ new size_ Attached garage: ❑existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No/ If yes, site plan review# Current Use /r1�S,�NGe Proposed Use T/, l✓G'� APPLICANT INFORMATION (BUILDER OR HOMEOWNER) j � Aurosr ux�' S Name I [.0 1� G �y 66 Telephone Number 7YJ- Address G 10052saewle License # C S OV527 &2 A _9 Home Improvement Contractor# Email C�I�Nt��J9L/�USTGG�SIAMOrker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO ��f SIGNATURE DATE 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 . r ; GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT _ ASSOCIATION PLAN NO. f i I • The Commmonweakk 600 Wad&gWx S4wd Bas&74 MA 02111 „ Wu iM& I<UMPeUkCM Iusm-mce Affidzz-Bmlde>tlOm ers scan#Ilformnatirn Please Print Eily gem G g& Aene an emplaper?Oteckthe appropriate box: Type of project(ram: I am a 1 �. � 4 ❑I am a geom-9 confiactur and I � ❑New �(f ff amfor�* have hircdfffe 2.❑ I am a sale prmpdetx orpartaw- fisted onihe aftmiled sue. �. ❑Reffiode�mg slip and have no employees �ese�have � E]DemnlEon wcding Forme iai any capacity- [NOwa comp. comp_ ��p_in * $ p- d' ti ❑ addifiou -1 5:❑ We are a cmPmatsmand its Imo❑E1ed�cai repairs or ad ons 3_❑I am.a homeooer doing all wmk ads have exercised d it , IL0 repa rhm6 agrepaim or ad&d= , myslif e afeset perum im regajte&j E p a>_52, §1(4),andwelavemo 12 RflaF LNG VAE& L3_❑�7ffiet cam-iasmame requh A] ;Anyspp5aat6,4c3— bcmzlmastelsefM=xt hesad=b9uw aPzry dcei;'amV=mb apmHcpia r� 1��maua�a�submit das KTRB is h sacs_ C�dms$sstd�ee7c9&boaez sRsddtticrostsix�eYsbo theauaeoftheseatcor s®elst e�het �not�nsee shsee e=glopem Ifthe mb�eshace emgTa} s,tfiegamsrpnnW1LL81 'ammp.li01ky amnb= I am era eriipfi�isr ffi�is prat�idirfg rvQrkers'carsRfiarc zrrsnraacs for ac;I*empfQ}�ee�. Bdaav is ate prr�cy mui}Qb site - --- . i$�arra�rliarL . Iasmance Cry Nmne: Paficp4ar €-imlc.Ac�oog6o�- roh Oa Addre= /s f1 L0 S�,lel �D c : Attach a oopf of the workere compmsationpolicg declara4ion MLL(showing f e policy der and eXPiration date). Faii=e to semm coverage as requinAunder 5wfion 2 5A o€MQ.n 152 can lead to fire imposifionofmiminApermN of a fine up to$L50D 04 aadfor ono-geerm xisonmeef,as w as cnrs1 peualiies is ibe foaa of a STOP WORK QRDER-and a r of up to 250M a clay abaiast ffie violafar. Be advised ffid a copy of fik zhh=emt may ba fxvwded izs tie Of x of Investigaliaas of-Me a DJA Rw' cgfixage,v am- Frfa&ersfrp csrL y tarrdar M Ofp4my fhatilrs hays and correct Phom A. ��� ��t�����be rareFfe#e�by�Y arta:� t • tky or Tan= PermftTlcense# h=dng rEtp(ch-de one): LBm=dofHkahk -.Buffirag Dew 3. Tcnm C[erk �L Elecrical Fnspector a.Ph=Mng Emspedmr ti.O&W C�ct Person Phan� . 6 r.a■it r•nl R _1 eta■ .•rR l{ N .-1.- -•.L.1�.. r.nvia r•T.l.W. 12: to a ra.I■ • •n ,.Y..I ■• tm i. 1:[■■1{ _n i/1) a:ia•�. :i - •rF•a■ it i. • :..•■■r In■ rrt.n.:r • ■a. N-•.i - •1. • ■■nf to •I•: ■1 •'■mart . JI II / •/ /ata r. : -.■ ■•.a Ial1: •t:. ■■�.F fat\ :z.V�•wl:n•]. ••t .t) .i.•Ia •I •t\ �•J: rrtta - •1 :f.• ••• •1 AN,01 - . i■ 7•: �-an- �■_r•r• n : ant rn■� usA' _n• .■ 1►nu: i■- -__ al �.r.u:■•.. . : •� � �. rnu .•r o i■ •r • ■ t '■r' • at a.l ■nY ■aa•rw■tp _LR•teYn al■ O •i\�. -'J: r■Ia aaalf • n: iiluf • :. - AN" •`••✓_ • .►•'- 1 t■ •.• - ..•n- ■• It•1 ■A:O in r .n:I ■a1�.I■. :.I• -•■f• Y.- O r r.■ ■1 i■ ■• via al t rrnf dal • n- a- 1 1■ ■.■A . :In a-1 i ••a! r.an r• /rw n■ n ■• tr:ntl■rt.n r H.V. ■rt as •I - ■..[ ••r.. 1 .• In■_ ■A- • •a. t■ -J •■a■• •; I of ■a.• :n■•1 I�.:/mi VI Pi iarf .. 1 a• ■rr:.m • ■ -a Ant• .•.t ral •- t rr■■r• n • :■■ rt■1• • �a • • V.:1■i.. 1■:1 - � •'Jr' _.�: �.■Y•a - a i - � ■t . • • .t lX• _•a i _ f _ _ • t �Z / ■ t. ! ■■ ■ r- :a■' . Ia,Mtl�X a ■• r■.Y• I r •n • It ,, n la r.ant■ ■ . ■. i■ .■• ' • ■ . �• _ • f t/ 1 a 1 ■ - r. t .■ 1 Aral -/ Y. a - 1::1 Y" riffeiast a • - f Y" ..A.I t.t- 1. .! - ■ r• ■ _ • .• tt m: 1 . Ci a J\ar Y `� r.•.. a1i•�+ a rnunl al•-•a Ii. ■t .0• • tw ■. n r t.■■• Y al■ t.1 �a1ar up. J■• ►.na■r-r t.l n r r.�u n■.n r • f■f 1 ••aa, nal■ rrr.r_• a ra • .:uu t:a - ••m - r■ m ru ras, • n .l a•tr ._ •:�.�• n ..:ralr a n i■- r.m _rm_ _nm an • I 71 a of in - ••a■.•r raltalr�t v:l■•• ..■ 1 r•lartf ■" . rAr ,•1.: 1.- r a(:. ■a-1 .If r • ■. •a.I YI.■-1..• -.t■ ■ ■rr�. .t may a A• ►alma :wiciff ..n1 r _!al r :u• •■n• nun .a+ ••: AN Is • n a as Ina ar• r\ t �anu.m�. al naalArt .• r' •a n rw na [il m• mien ■•-••- .i•� ■■.n it- ■m ra•r . f.■ .. a ■• r.n1 ►. a• r■■ ••.■.a:+w r•tlr[f r,.w l alt .■ t■ :n►- .a. \t • ■• rJ■t• • •. ra.■I ►. .• -■ a.[ al tt!_ I 1■_ r" ■ntn(a{r■ a• to- �rf.1■■•mall •• ■al► ■.- r.!.�.Il. I• ,of slalom■-t all • It •t -a►' rr ■ • U a •_ ■ -L■■ . _ ■' .t. ■..- ••• = ■■/ / ■t ►- - .•/■■r. ■. �■" MI .1 rt••. t.:1 t■ -Ir■m r:■.II lal tt- •rftnl . ■ r■ •iin' �■■:+,[r[ t . t■- �'..■ ■n r■ t as a. - rM.�Uw yl.a ■ •.. a: -tt' !•w■.1[ :1 a1n al t . •a :■ r••a r. If •f\:all ••..•r r• 1 ■ r.1 is r..tun ru _ n- anal. arm .- ■•• - n vie ra ealuu Ju-. ■•a a :�. :1 u' r r• - Allies.r. al. .a- -u al f•n•.n" m" • - • .t t..l at -at•-•I ►alt■n rl-' :a. •.Itt[r• i-J r • to �•:[ Its r.l t- al • .♦a t r J a■ ••alnal • asJn■_ 1 No .t a HI .n n u: rn n Onr • .••.t_.n n■ •: a ..nt■:r -t■ "_.t uu ■. :n. v.■ I. ■■ IN tt •rJn It r. n\n■•r ..a I 1 • t\►■ _ Ir �r nrnA t•! a •.in■r■ at .t.• raa [•.■ ■. . `•a•n 1 IN I Int• NO r.al Ia r:1• :im• r:a•Il n .tt• 'l•it •KI .Aral •■ .al■■ 1 rl1 ■■• •1 1.■ r:a■• ■n r. f• n •t•n .•at t r►w .. :a a t.■t.� •f 111- - a.] i+`A is- _n r rtn •• ! ••.1.. :� •raft n A 1••'. .t • t. is..• t .t.1 .. .rrl •at r 1• Y.tnn r. •I t•.It.lr. r• i■ wl a ■••'al ■■ . ft •• .rt t. to" :.r• tCn. a .• ■..t 11131111 tt•:• 1 .■ CI IN I.nn r rat It. al ►.+r ■ i.•. 1 np f" 11�. •./ -. i:. Af■ _ a.■. - rates ►rt •t .r■A• 1 I• :nr• [• .1■ •r Yn ti. a r.lr•n■�! w- •ilan.l ■• rr. f m:gat• 1 10 •.:t. rt.t• r. a! r.11ll• Y.l� a■. ■f•- to • a all ••.■ • .� r• n J.. •.1 II ■ -Ia►• Ial •••[ ►.•r r .n•It :n• a•t ■ •.• ■- •■• ■•^•.I■ ■r ■• •wY1Ya■ 1. •J• AI. : •.: 1 `■- O-0 a ■n WN : MAN n- A rr■.n .B. Y.t ■lilt[r ■- •,Hitt�_/ ••ev_ to • 6 S\v: ■ t\r,�{. 1•Pt.11 Its�� i t t1�:.yt■- t tit t` i ii-� ►J - �a 1 I tfY �® CERTIFICATE OF LIABILITY INSURANCE ;. DATE(M DDNY 016 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 endorsemengs). PRODUCER UONTACT NAME: Justin DeLoach MCSWEENEY AND RICCI INS AGENCY INC PWC.HONNo.EExtil (781)848-8600 A/C No: E-MAIL ADDRESS: jdeloach@mcsweeneydcci.COm PO BOX 850984 INSURERS AFFORDING COVERAGE NAIC# BRAINTREE MA 02185 INSURERA: ATLANTIC CHARTER INS CO 44326 INSURED INSURER B: AUGUST WEST CHIMNEY CORP INSURER C: INSURER D: 6 RIVERSIDE DRIVE INSURER E: PEMBROKE MA 02359 INSURER F: COVERAGES CERTIFICATE NUMBER: 57073 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. INSR TYPE OF INSURANCE ADDL SUER POLICY NUMBER MMIDD/YYYY MM/POLICY EFF D Y EXP LTR IYYYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ —ffRENTED CLAIMS-MADE OCCUR PREMISES SAGEES(Ea occurrence) $ MED EXP(Any one person) $ N/A PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY❑JECT LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED N/A BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTYDAMAGE $ HIRED AUTOS AUTOS Per accident $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ -:4EXCESS LIAB CLAIMS-MADE N/A AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION OT AND EMPLOYERS'LIABILITY YIN X STATUTE ERH ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 100,000 A OFFICER/MEMBEREXCLUDED? I NIA1 NIA N/A -WCV00965505 05/19/2016 05/19/2017 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 N/A DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay claims for benefits to employees in states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this certificate was issued(unless the expiration date on the above policy precedes the issue date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at www.mass.govAwd/workers-compensation/investigations/. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town Of Pembroke . ACCORDANCE WITH THE POLICY PROVISIONS. 100 Center St AUTHORIZED REPRESENTATIVE Pembroke MA 02359 Daniel M.Cr y,CPCU,Vice President—Residual Market—WCRIBMA ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD < posat# 1006183BBA AUGUST WEST CHIMNEY & FIREPLACE CONCEPT`` PEMBROKE LOCATION: wWw.augustwestyllreplace.com flWiGHAM LOCATION: 6 Riverside Dr. PHONE: (800)959-1511 FAX: (781)826-6195 32 Whirin : > Pembroke,MA 02359 Hingham.,MA 02043 'U/8/2016 Beth 0deri 15 Old Shore Road otuit.Ma. 02635 Payment Terms Phone: 781-258-8636 1/3 Dep.,l/3 Start,Bat.Comp AUGUST WEST CHIMNEY& FIREPLACE CONCEPTS PROPOSES THE FOLLOWING: scripbon Qiy i oiai August West Chimney Co.recommends the following rebuild from roof lines up, for two brick constructed chimney casings at 15 Old Shore Road Cotuit MA,.cam:. Cod, Driveway Side Single Flue Fireplace. Set-up scaffolding tower in front of chimney and roof. _1. .,., 185.00 Take down chimney casing about 3 Brick corses past roof line.Dispose of all oIt1- brick and masonry from Job site. a Reconstruct new clay brick chimney casing with solid stairrated bricks,mortar and new lead flashing at roof line.Bring new brick casing height up to code. Masonry Materials 1 975.00 LEAD FLASHING 1 280.00 Labor 4.650.00 Permit Fee 100.00 1 FINAL COSTS SUBJECT TO CHANGE UPON FIELD INSPECTION: Subtotal $6,190.06 • 1Y SERVICES NOT IMPLIED 17V THIS PROPOSAL ARE NOT INCL UDED IN THE INSTALLATION COST. Sales Tax(6.25%) $0.00 PAST DUE BALANCES are subject to a monthly finance charge of 1.5% Total $G,190.00 tea orders are suniecr ro a ij%re-srocking jee. Special orders are non-rejunaaote. Respectfully Submitted by, :. JW ACCEPTED. The above specifications,conditions,and prices are satisfactory and hereby accepted.August West is authorized to furnish materials and/or labor as NOTE: THIS PROPOSAL MAY BE WITHDRAWN u proposed Payments will be made as required by this agreement NOT ACCEPTED WITHIN 30 DAYS. Date of Acceptance: //�//��/ Signed C� f Massachusetts Gepar meat of Public Safety Commonwealth of Massachusetts 3 Department of Public Safety Board of Building Regulations and Standards License: CS-023887 License. B U-021741 Oil Burner Technician Ce ir,_ate won rri Suc=' ` JEFFREY S LUDLOW = Arm JEFFREY S LUDLOW 28 SALT RIVER RD 28 SALT RIVER RD a' v E FALMOUTH MA 02536 E FALMOUTH MA 02536 y Expiration: =xpi ration: ` 06N5/2018 Commissioner 06/15/2018 Commissioner Office of Consumer Affairs S.BusMess Regulation HOME IMPROVEMENT CONTRACTOR �,r Registration: 107353 Type: . � Expiration 7/31l20.18 Private Corporation A 4� ' , 1 ' 1:n 1 r : AUGUST WEST CHIMNEY COMPANY,INC. Jeffrey Ludlow F.I.R.E. Certified Inspector 6 RIVERSIDE DR r411111 t p , #FCI-1$3 PEMBROKE, MA 02359 Undersecretary _ Fire ItIVeS00.:1tion ROeM'Ch&Education SCI-6:e we.f-i-r-e-sen ice.com Tel:80i 957 9955 - I OSHA r o e • a U-S.Department of Labor Occupational Safety and Health Administration Student*47402 Certificate#: 16231 Jeffrey Ludlow Jeffrey S. Ludlow I has completed a 10-hour Occupational Safety and Health Training Course in Competent Person Training: Construction Safety&Health Frame Scaffold Randall Purser 2( 6/2007 Class Date:August 25,2010 Expiration Date:August 24,2013 1 Authorized By: Authorized Training Institute: (T.ciner) (Date: SIA Training Program, r3;? �r l � , 9� Ord r � t J ' N i Town of Barnstable CFTHE Regulatory Services Richard V. Scali,Director • Building Division E:;�z RNSTABI;E + &U NSTABLE, • -" ; � Thomas Perry, CBO 39.5 ` 79-2014 Building Commissione 200 Main Street, Hyannis, MA 02601 www.town.barnstable.maxs Office: 508-862-4038 Fax: 508-790-6230 March 4, 2016 RE: 15 Old Shore Road, Cotuit To Whom It May Concern, I have reviewed the files and conducted a site visit on March 2, 2016 and have determined in my opinion that the property located at 15 Old Shore Road, Cotuit, Map 035 Parcel 074 is a pre-existing two family home. Respectf y, omas Perry, CB Building Commissioner f SARAN E ALGER, P.C. ATTORNEYS AT LAW FIVE PARKER ROAD•POST OFFICE BOX 449 OSTERVILLE,MASSACHUSETTS•02655 TELEPHONE:508-428-8594 FACSIMILE:508-420-3162 )OHN R.ALGER 1931-2007 SARAH F.ALGER TWO SOUTH WATER STREET sfa@sfapc.com NANTUCKET,MASSACHUSETTS•02554 TELEPHONE:508-228-1118 CHRISTINEA�ENNESS FACSIMILE:50.84228-8004 caj@sfapc.com -_-7 = .d..- January 29, 2016 A J � D_ Mr. Thomas Perry Building Commissioner Town of Barnstable 200 Main Street Hyannis, MA 02601 Re: 15 Old Shore Road, Cotuit. MA (the "Property") Dear Mr. Perry: Our office represents Nancy Grant who owns the above-referenced Property. Mrs. Grant has requested our office to obtain a letter from the building department confirming that the apartment located on the Property is a pre-existing nonconforming use. As background,this Property was built in the 1740's. Mrs. Grant and her late, husband,John M. Grant,Jr., purchased the Property on October 10, 1973,by deed from Dorothy F. Tompkins, duly recorded with the Barnstable Country Registry of Deeds in Book 1947, Page 295. A copy of the deed is enclosed. At the time the Grants purchased the Property, it contained an apartment which was part of the main home and consisted of a living/dining room area, kitchen, 1 bathroom downstairs and 1 bedroom upstairs. The Grants were told that the apartment was added to the main home circa 1900. No additions were made to the main home during the Grants' ownership of the property. The Grants have rented.the apartment throughout the years. In fact one of the renters was through the Barnstable Housing Authority and there have been private renters as well. Copies of tax forms reporting rental income from the Property have been enclosed along with an affidavit by the homeowner, Nancy Grant. � 1 SARAH F. ALGER, P.C. Thomas Perry, Building Commissioner January 29, 2016 Page 2 The Property is presently under agreement with a scheduled closing date of March 4, 2016. Mrs. Grant would be grateful if you could issue a letter or memorandum stating that the apartment located on the Property is a pre-existing non conforming use. Thank you very much for your assistance. Please contact me if you should have any questions or require any additional information. Sincerely yours, Christine A. Jenness Enclosures Cc: Nancy Grant .�.._.__.._._..__.. ... .. _._.._•Booa194'7 fatal 295 MASSACNUSETTS QUITCLAIM DEED SNORT rURM (INDIVIDUAL) 881 I, Dorothy. F. Teslpkias 31639 of Barnstable (Cotuit), Barnstable County,Massachusetts, being unmarried,for consideration paid;and in full consideration of Sixty-two Thousand Five Husdrod (62,500) Dollars, gf3nts tv John M. Grant, Jr., and Raney J.-Grant, husband and wife, at tenants by the entirety, botk Of. 114 South High Street, Foxboro, Massachusetts,with 411tiflultn tvurnuuis i i the land in said Cotuit, together with the buildings tkereon, situated in that part of the Town of Barnstable called Cotuit, Barnstable County, (Descri tion and encumbrances,if any) - Massachusetts, bounded and described as follows: Beginning at the Northeasterly corner of land formerly owned or occupied by Lizzie X. Lovell, now owned by Nolen W. Robinson; Thence Easterly by `ld Shore Read, formerly called last Main Street, as the fence now stands, to land formerly of John Y. Sturgis; Thence Southerly by lalad 8ormorly of said Sturgis, as the fence new stands' to land formerly of John C. Fish; TL oce Westerly by land formerly of said Fish to land-now or former- ly of Thomas Chatfield; , Thence Northerly by land now or formerly of said Chatfield, as the fence now stands, ninety-sir. (96) feet; Tkence Westerly by the fence to a corner, three,(3). feet from tke voodhouse now or formerly of said Chatfield; Thence Westerly.by.a fence to the open passageway; Thence Northerly aoress said passageway. to the. Southeast corner of land formerly owned or' occupied by said Lovell, and now. owned by said Robinson; + Thence by said land formerly of said Lovell and now of Robinson, to t the first mentioned bound and the point of beginning. ' Containing one and one-quarter (l ) sores, more or less. . There is. also included a right of way to and from the'domised prom- ises to Main Street, as the name is now used. I` said premises are conveyed subject to and with the benefit of rs- trictions and agreements in deed of Helen W. MacLellan to David A. Rob+ i inson et ux., dated November 5, '1946, recorded with Barnstable County Registry of needs Book 659, Page 358, and other encumbrances of record; i so far. as the sane are in force and applicable thereto For Grantor's title see deed of Ernest G. Wiggins •st ux dated April 15, 1965 recorded Barnstable Deeds Book 1294 Page 625. i 13itnran•••my....hand and seal this..•....��ZH day of.•......lGt.1t1R x...........:... I,9...T.3.• COMMONWEALTH OF haA.SSACHUSF;TS •• • t 1- ................. ..... .............•............r......•. o IRZTR37 r. .. . . i�gr mnmatnnurrttltfl of $iassarllusrffs - I � Barnstable. ss.• October /0 19 73 Then personally appeared the above named Dorothy� F. Tompkins _ i and acknowledged the foregoing instrument tc•be her free act and deed,before,me .. .. '1....................................• • I /'+ p [I1l, /�T 1 0 1973 Qetwaa,a 1. jelLpay Notary Public—Jetefce f dit mote RECORDED Oli My commissionc*res2 _ Ff6"4&r ;1 19ra j I (*Individual—Joint Tenants—Tenants in Common—Tenants by the Entirety.) CHAPTER 183 SEC.6 AS AMENDED 9Y CHAPTER 497 OF 1969 Every deed presented for record shall contain or have endorsed upon it the full name,residence and post office address of the grantee - and a recital of the amount of the full consideration)hereof in dollars or the nature of the other consideration therefor,if not dcliveted for • a specific monet'Iry sum. The full consideration shall mean the total price for the conveyance without deduction for any liens or en. 1 • cumbrances assumed by the grantee or remaining thereon. All such cndortcmrntt and recitals shall be recorded u part of the deed. Failure to comply with this section shall not affect the valty of any deed.'No register of deeds"it accept a deed for recording unless it is in compliance with the requirements of this section. Print Page Page 1 of 4 Print this page f • Owner Information - Map/Block/Lot: 035/074/-Use Code: 1010 Owner '. Map/Block/Lot,GIS MAPS GRANT, NANCY J 035 /074/ Owner Name as of 7H RIVERVIEW Property Address 1/1/15 AVENUE 15 OLD SHORE ROAD MASHPEE, MA. 02649 , Village: Cotuit Co-Owner Name Town Sewer At Address: No GIS Zoning Value: RF • Assessed Values 2015 - Map/Block/Lot: 035/074/-.Use Code: 1010 2015 Appraised Value 2015 Assessed Value Past Comparisons Building $ 366,200 $ 366,200 Year Total Assessed Value: Value Extra $ 10,200 $ 10,200 2014,- $ 1,162,800 Features: ,2013 - $ 1,162,800 $ 3,300 $ 3 300 2012 - $ 1,097,000 Outbuildings: 2011 7 $ 1,119,500 Land Value $ 783,100. $ 783,100 2010 - $.1,120,900 2009 - $ 1,104,500 2008 - $ 1,106,700 2015 Totals $ 1,162,800 $ 1,162,800 2007- $ 1,106,700 Residential Exemption Received=$87,192 • Tax Information 2015 -Map/Block/Lot: 035/074/- Use Code: 1010 Taxes Cotuit FD Tax (Residential) $ 2,581.42 Community . Preservation•Act,Tax $300.09 Town Tax (Residential) 1 0,003.15 Fiscal Year 2015 TAX RATES HERE , 12,884.66 http://www.townofbamstable.us/Assessing/print l 5.asp?ap=0&searchparce1=03 5.074 12/23/2015 Print Page Page 2 of 4 • Sales History- Map/Block/Lot: 035 /074/-Use Code: 1010 History: Owner: Sale Date Book/Page:' -Sale.Price: GRANT,NANCY J 1989-11-07 6947/229 $1 GRANT, JOHN M JR&NANCY J 1973-10-10 1947/295 $0 • Photos 035 /074/- Use Code: 1010 _ o WN U r XO • Sketches - Map/Block/Lot: 035 /074/- Use Code: 1010 P _11< IN i 1 F �s x BA Y4rzu�It tFUSW � 3BAS ,� , t `qh""}' v r" 14t �� y S�•'GF M£'* 9 b. � W9yi'Sv.n I 10 As Built Cards:Click card#to view: Card 41 • Constructions Details-Map/Block/Lot: 035/074/- Use Code: 1010 Building Details Land Building value $ 366,200 Bedrooms 6 Bedrooms USE CODE 1010 Replacement Cost $488,320 Bathrooms 4 Full Lot Size 1:1 . (Acres) Model Residential Total Rooms 13 Rooms Appraised $ 783,100 Value - j i http://www.townofbarnstable.us/Assessing/printl 5.asp?ap=0&searchparcel=03 5074 12/23/2015 i Print Page Page 3 of 4 Style Colonial Heat Fuel Gas Assessed Value $ 783,100 Grade Custom Plus Heat Type Hot Water Year Built 1740 AC Type None Effective 25 Interior Wide Pine depreciation Floors Stories 11/2 Interior Drywall Stories Walls Living Area sq/ft 4,000 Exterior Walls Wood Shingle Gross Area sq/ft 4,102 Roof Gable/Hip Structure . . Roof Cover Asph/F GIs/Cmp • Outbuildings & Extra Features - Map/Block/Lot: 035 /074/ Use Code: 1010 Code Description Units/SQ ft Appraised Value Assessed.Value FOPC Open Prch-roof, 102 $ 3,300 $ 3,300, ceiling FPL2 Fireplace 1.5 2 $ 6,900 $ 6,900 stories SHED Shed 264 $ 3,300 $ 35300 • Sketch Legend Property Sketch Legend 132N Barn-any 2nd story area FPC Open Porch Concrete Floor REF Reference Only BAS First Floor, Living Area FTS Third Story Living Area SOL Solarium (Finished) BMT Basement Area FUS Second Story Living Area SPE Pool Enclosure (Unfinished) (Finished) BRN Barn GAR Garage TQS Three Quarters Story (Finished) CAN Canopy GAZ Gazebo UAT Attic Area (Unfinished) CLP Loading Platform GRN Greenhouse UHS Half Story(Unfinished) FAT Attic Area(Finished) GXT Garage Extension Front UST Utility Area(Unfinished) FCP Carport KEN Kennel , UTQ Three Quarters Story (Unfinished) FEP Enclosed Porch MZ1 Mezzanine, Unfinished UUA Unfinished Utility Attic FHS Half Story(Finished) PRG Pergola UUS Full Upper 2nd Story (Unfinished) FOP Open or Screened in PRT ` Portico WDK Wood Deck Porch PTO Patio - i http://www.townofbamstable.us/Assessing/print l 5.asp?ap=0&searchparcel=03 5074 12/23/2015 i AFFIDAVIT I, NANCY GRANT, of Mashpee; Massachusetts, having personal knowledge of the facts herein stated, under oath depose and say as follows: 1. I am the current owner of the property located at 15 Old Shore Road, Cotuit, Massachusetts, being shown as Parcel 074 on Barnstable Assessor's Map 035 (the "Premises"). 2. On October 10, 1973, my late' husband, John M. Grant. Jr. and 1, + purchased the Premises by deed fecorded. with the Barnstable CoL:nt\' Registry.of Deeds in Book.1947, Page 295. 3, At the time we purchased the Premises in 1973, the Premises had an. apartment: 4. _ No additions have been made to the main house during my,ownership of the Premises. 5. The apartment is attached (part of) the main home and consists of the following: living/dining area, kitchen; 1 bathroom downstairs, and a single bedroom upstairs. 6. The apartment has been rented off and-on during the years since we purchased the property, One of the renters during the years was the Barnstable Housing Authority but there have been private renters as wcll. 7. Copies of 1099-Misc Form showing rents received from the Barnstable Housing Authority for the years of 1992, 1994, 1995, 1997, 1998, 1999. are attached along with copies of Schedule E of Form 1041 for the years rnni ', ini ;nno n n;n , , , , r c .,.,, F, 1 7;1, t 96, 1 7`ro, 20080, 20.1 0 and JC1ieClule 1✓-'1 of 1V1dJSdCnUSett� IIICOme Tax Fornn.2 for the vears of 1996, 2008 and 2010-are also attached. Signed Linder the penalties of perjury this ,Ih day of January,-2016. CA— NANCY GRAN-IV. s . STATE OF FLORIDA COUNTY OF��• c �/I ►� On this'�Z day of January, 2016, before me, the undersigned notary public. personally appeared NANCY GRANT proved to me through satisfactory evidence of. identification, _which was O1A D[ ff'5'(P"r4(P i0,/* to be the. person whose name is signed on the preceding or attached document, and acknowledged to me that he signed it voluntarily for its stated purpose. Notary Public — __------ My Commission Expires: flvl i CHRISTINA HUTCHINS Notary Public-State of Florida ,91 .oQ My Comm.Expires Aug 25,2016 %TOFF o Commission#EE 195488 II _ , ❑ CORRECTED if checked PAYER'S name,street address,city,state,ZIP code,and telephone no. 1 Rents OMB No.1545-0115 BARNSTAB 4E HOUSING AUTHORITY $ 2664.00 146 SOUTH STREET HYANNIS, MA 02601 2 Royalties nogg Miscella'nem 3 Otherincome InCplY $ Form 1099-MI$C PAYER'S Federal identification number� $ RECIPIENT`S name 6 Medical and health payments Nonemploye9compenaetion NANCY GRANT $ care PaY COPI B Substitute payments In lieu of 9 Payer made direct sales of To be fil Street address(including apt,no.) dividends or interest $5,000 or more of consumer W Products to a buyer reciplen P.O. BOX 119 $ (recipient)Tor resale P. state Incol City,state,and ZIP code 10 Crop insurance procppds 11 State income tax withheld tax retu COTUIT MA 02635 wh Account number(optional) 2 � requlrt State/Payer's state number 13 Form 1099-MISC Department of the Treasury-internal Revenue San j I 3 - .-- ------ _ — ................ -- -- i ❑ CORRECTED (if checked) PAYER'S name,street address,city,state,ZIP code,and telephone no. 1 Rents OMB No.1645-0115 � i BARNSTABLE HOUSING AUTHORITY $ 146 SOUTH STREET 2 Royalties (� Miscellanea ' HYANNIS, MA Ua601 $ `Q 3 Other ineorr,a Incon $ Form 1099-MISC PAYER'S Federal identification number 4 Fedora[income tax withheld 5 Fishing boat proceeds $ RE P E name 6 Medical end health care payments 7 Nonemployee compenaation Cop NANCY GRANT $ $ To be If i 8 Substitute payments in lieu of a Payer made direct pales of street addreas(including apt.no.) - :dividends or Interest $5,000 or more of consumer roeipie ' produots to a buyer P•0. BOX 119 $ (recipient)for resaleEl state inec I City,state,and ZIP code 10 Crop insurance proceeds 11 tax reti Stara income tax withheld 1N1 $ $ requil j Account number(optional) 12 State(Payar'e atgtQ number 13 $ {f Farm 1099-MISC Department of the Treasury-Intemal Revenue Sc ❑ CORRECTED (if checked) PAYER'S name,street address,city,state,ZIP code,and telephone no. I Rents OMB No,1645-0115 BARNSTABLE HOUSING AUTHORITY $ 146 SOUTH STREET 2 Roy27ties %97 [Miscellanea HYANNIS, MA 021601 $ lnCOr w 3 Other income . l $ Form 1099-MISC PAYER'S Federal identificat on number 4 Federal income tax withheld S Fishing boat proceeds i RECIPIENT'S name 6 Medlcal and health care payments 7$Nonomployee compensation Cop? NANCY GRANT $ $ To be fi _ 8 Substitute pa ments In lieu of 9 Payer made direct sales of N i Street address(Including apt no.) dividends or Interest $5,000 or more of consumer r13Clpler 1 products to a buyer state P.O. B 0 X 119 $ (recipient)for resale► El info tax reft i City,state,and ZIP code 10 CroP insurance proceeds 11 State income tax withhafel wI r COTUIT MA 02629 $ $ requir CORRECTED if checked PAYER'S name,street address,city,state,and Zip coda 1 Rents OMB No,1545-0115 BARNSTABLE HOUSING $ 3 894.00 s AUTHORITY Royattics Miscellaneous 146 SOUTH STREET $ HYANNIS MA 02601 3 Other income Income $ .00 Font, 1OWKSC PAYER'S Federal identification number $ .00 $ Account number(Optional) 6 Medical and health tare payments 7 Nonemployaa compensation COPY 2 $ .00 $ .00 To be filed Botch No., Co.coda:, Fill&No, 8 Substilute payments in lieu of 9 Payer made direct sales of V ft 9 5/4/0 7 3 BFV 043177, dividends or interest $5,000 or more of consumer reolpientfa products to a buyer �tdt Income RECIPIENTS name $ (recipient)for resale■ ❑ 8 t return,NANCY• GRANT o crop insuritnGF prt7GL'Cd5 11 State income tax withheld whet. P` O BOX 119 $ $ .00 required, COTU I T MA 02635 2 State/Payer's state number MA . Form 1099-MI$G Department of the Treasury-Internal Revenue Service PAYER'S name,street address,city,state,and ZIP coda lilCOme talc withheld 5 Fishing boat proceeds. $ Account number(optionap dical and health bare payments 7 Nonemploytre Compensation Ct,py 00 $ ` Batch No., Co, Code, File Nostitute payments in lieu of 9 Payer made direct sales of0 7o beIeC 94 4 150 13FV dends or interest with 0 4 317 7 $5,000 or more of consumer raei i , RECIPIENT'S name $ Products to a buyer- P enta NANCY GRANT (recipient)for resale ► 0 state income 0 Crop insurance proceeds 11 State income tax withheld WX return, P 0 8OX 119 $ $ when COTUIT KA 02.635 .00 required. 2 state/Payer s state number MA Form 1099-MISC Department of the Treasury-Internal Revenue service I CORRECTED (if checked) PAYER'S name, atrtat addtaaa, city. tt.t..nd zip c.de 1 Rants_ - BARNSTABLE HOUSING 4,090.00 OMB No. IS45-0115 AUTHORITY z Royaltiaa ���� 146 SOUTH STREET .UQ Miscellaneous HYANNIS MA 02601 3 Prllae, awards. etc. Income PAYER'S Federal {dantlflc4flon number s00 r1 Account number lopuenatl Medical & health care Payment 7 Nvnempioyas compensation copy 2 ) .00 .00 To be filed 8.1ch No., Co. Code, File No. 8 Subatltvfe payments In Ileu of $ Payer made dirbut Was of With l 92/4/p+f �f 1 y pL.ff 7 Clvidondc or Interest 95,000 or more or at)-sumer reClfSfont'$ 211 B Y 04317-7 products to a buyer _ (recipient) fpr rassla ❑ state Income RECIPIENT'S name IftreL middle,1ret1, addreaa, and ZlP. code I NANCY GRANT 10 Crop Insurahoa rccaada t1 tax return, P $tatq fncomo T.)S W+thhald i GRANT N. 0329 SQ.,:RULE E Supplemental Income and Loss 0Ma No. 1545-0074 ''. {Form 1040) (From rental real estate,royalties,partnerships,estates,trusts,REMICs,etc.) 0eputment of the Tressury t•'Attach to Form 1040 or Form 1041. 1992 Internal Revenue service Attachneal ► See Instructions for Schedule E(Form 1040. sequence No. 19 Names)shown on return - ,NANCY J. GRANT Income or Loss From Rental Real Estate and Royalties Note:Report income and expenses from the rental of personal property on Schedule C or C—EZ. Report farm rental income or loss from Farm 4935 on page 2,line 39, 1 (Show thhee�.kind and lyocya�t7iio7n7 of each rental real estate property; for each rental yes No .. ..................... . .. . real property listed Tn ..,.....�• .. property Ae8 r�...Q.hlFSi. h� Q l... ........................ aays line 1, did silly man IA for p■ta■dtl ... ......... ............. ................................. ................. ....... ............ .......... .........--- —---- ................. ................ ......... purposes fur *ore than the .........:........... ......................................................................................-..-..................................................................... grew(er of 14 days or 10x B - of the total .......... ................................................_...:_.__..................................................................I............................................... days rented at C _ We r■.tal 1c : ......................................:............:.........................................................................—................................................••••••••• valaa darlaqthe tax yearn Income: Properties Totals A B C (Add columns A,8,and Q 3 Rents received , , , 3 4,090. 3 090 4 (loyalties received - 4 4, Expenses:, 5 Advertising. . . . _ . 5 B 6 Auto and travel .- n 7 Cleaning and maintenance 7k 8 Commissions. . . 8 9 Insurance . . . _ . . . 9 96, �xo 10 Legal and other professional fees. 10 sx1 11 Management fees . 11 Ze 12 Mortgage interest paid to banks,att:. . 12 12 13 Other Interest. 13 x; 14 Repairs -Carpenter,screens,etc. 6:6 -Electrical and plumbing. ° -Painting and decorating. 14 -Rt+gfine a6. -Miscellaneous . . . 1.042, 15 Supplies . . . . . . . . 15 a 16 Taxes . . , . . . , 17 Utilities . . 17 18 Other(list) ►....... ........................ .............................. ......................... 18 e 19 Add lines 5 through 18 79 2,7.69. 19 24769. 20 Depreciation expense or depletion 20 20 21 Total expenses.Add lines 19&20 21 2.769. M 8#:{ 22 Income or {leas)from renter fowl estate or % Rk royalty properties. Subtract Ilse 21 from un■ 9 fronts)or line 4 Iroydilea). if the a WWI is■00s7S,yee pwya E-2 to Had out ,L2 _ if you must file form 6188 1.321. a F, 23 Deductible rental real estate loss. Caution. Your renral real estate loss o i on line 22 may be limited .See page ° F-3 to AW out if you mug flle Form 8582 . . . . . . . , 23 ale. 24 income.Add positive amounts shown on line 22. Do not include any losses. . . . . . . 24 1 w 321, t 25 Losses. Add royalty losses from line 22 and rental real estate losses from line 23. Enter the total losses here 28 26 Total rental real estate and royalty income or(loss). Combine lines 24 and 25. Enter the result here. If Parts II. III IV, and line 39 on page 2 do not apply to you, als enter this amount on Form 1040, line is, thervvis (nolude this amount in the total an line 40 on a e 26 For Paperwork Reduction Aat Not",we Form 1040 Inatructiona H788 Schedule E(Form 1040) 1992 s21B6e 12/0{!92 i 6 SCHEDULE E Supplemental Income and Lass OMB No.1545-0074 (Form 1040) (From rental real 08tate,royaltles,partnerships, 1996 Deparirnent of Treasury S eorpordtlons,estates,tru4t9,REMIC9,etc.) Attachment Internal Rev.Service 99 Y Attach to Form 1040 or Form 1041, ► See Instructions for Schedule E Form 1040). Secluence No.13 Name(s)shown on return I " K Income or Loss From Rental Real Estate and Royalties Note:Report income and expenses from your business of renting personal property on schedule.C or C-EY(see page E-1).Report farm rental income or loss from Form 4=on aqe 2,line 39. 1 Show the kind and location of each rental real estate pjro arty: 2 For each rental real estate Yea No A RESIDENTIAL RENTAL property listed on line 1,did you 15 OLD SHORE ROAD COTUIT, MA 02635 or your farrily use it for personal A X purposes for more than the B greater of 14 days or 10%of the total Jaya rented at fair rental B value during the tax year?(see — -— page E-1.) G Income: Rrd ertles Totals A B C Add Columns A,9,and C.) '3 Rents received ................... 3 9,706. 3 9r706. 4 Royalties received.. 4 4 Expenses: 5 Advertising .............. ........ 5 a 6 Auto and travel see ( page!:-2)....... 6 a, 7 Cleaning and maintenance..,,•...... 7 P 8 Commissions................... 9 Insurance ....•.... 9 266. 10 Legal and other professional fees,.,... 10 11.Managementfees................. 11 12 Mortgage interest paid to banks, etc.(see page E-2)................. 12 12 13 Other interest..................... 13 14 Repairs.......................... 14 %a 15 Supplies ....................I—, 15 717. a 16 Taxes ..... 16 1,544. 17 Utilities.... 17 1,980. 18 other(list)► 18 s � i ' l 19 Add lines 5 through 18 .............. 19 4,507. 19 4 . 507. i 20 Depreciation expense or depletion (see page E-2). ......... ....... 20 20 i 21 Total expenses.Add lines 10 and 20..... 21 4,507. I 22 income or(loss)from rental real Bstate or royalty properties.Subtract i line 21 from line 3(rents)or line 4 (royalties).If the result is a(loss),SeA page E-2 to find out if you must file Form 8198 .,.. ............... 22 5, 199. E ' 23 Deductible rental real estate loss. '` Caution: Your rental real estate toss on line 22 may be Iimfted,Sae ' page E-3 to find out if you must s file Form 8582 Real estate ' Professionals must complete line 42 on page 2...................... 123 24 Income.Add positive amounts shown on line 22.Do not include any losses .................. ,,. 24 25 Losses.Add royalty losses from Une 22 and rental real estate losses from line 23.Enter the total losses here.,,. 25 26 Total rental real estate and royalty Income or Pose).Combine lines 24 and 25.Enter the resuft here,If We 11,III, i IV,and line 39 on page 2 do not apply to you,also enter this amount on Form 1040,line 17.otherwise,include 1 this amount in the total on line 40 on RO 2.. 26 5r199. ! For Paperwork Reduction Act Notice,we Form 1040 Inst CAA E12 NTF 6459 Preparers Edition Schedule E(Form 1040)19e8 CopyriOhtForMF Software o„ly,1096 WOO,Ine. NOBSCHEI 'cHEcuLE E Supplemental Income.and Loss OMB No.i54s-oo74 (Form 1040) (From rental real estate, royalties, partnerships, 1998 Department of the Treaso .ri corporations, ns, estates,trusts, REMICs, etc-11, Attachment Intemal Ravenuv Service 99) <r Attach to Form 1040 or Form 1041. ►See lrtstructlons for Schedule E Form 1040). Sequence No.13 Name(s)shown on return Income or Loss From Rental Real Estate and Royalties Note:Report income and expenses tram your buslness of renting Personal property on Schedule C or C-EZ(sea page E-1)_Report farm rental Income or foss from Form 4W5 on a e 2,IIt1e 39, 1 Show the kind and location of each rental real estate roperty: 2 For each rental real estate Yes No RESIDENTIAL R%NTAL prop"listed on line 1,did A 15 OLD SHORE ROAD COTUIT, MP, 02635 thetoou r your year for peruse sonal pur- poses A X B — - poya for 9more than greater of; «10%of the total days rented B at fair rental value? (See page E-1.) C Incoms: Properties Totals A B C (Add columns A,B,and C.) 3 Rente received ................... 3 9, 815, 3 91815.. 4 Ro allies received................. 4 4 Expenses- 5 Advertising ...................... 5 6 Auto and travel(see page E-2).... 6 7 Cleaning and maintenance...... 7 8 Commiselons................... 8 rx 9 insurance .. ... ................. 9 290 , 10 Legal and other ptofessionsJ tees_:._ .. 10 11. Management fees.......... ..... 11 i 12 Mortgage interest paid to banks,etc. . i (see page E-2)..... ......,,... 12 12 ; 13 Other Interest.......... ........ 13 8 14 Repairs........ ............... 14 170., .. 15 Supplies................. 1.5 16 Taxes ..__ ...... .. ... , 17 Utilities.................... .... 17 1,229 . J p 18 Other(list)► „ d, k i - 1 g i . f 19 Add lines 5 through is .............. 19 4 L.327: 19 4,327. , 20 Depreciation expense or depletion (see page E-3).................... 20 100. 20 21 Total expenses.Add lines i9 and 20._;, 21 4,427. 22 Income or(loss)from rental real estate' or royalty properties,Subtract line 21 _ «1 from line 3(rents)or line 4(royalties),11 e the result is a(loss),sea page E-3 to _ I find out if you must file rorM 61!M ..:._ 22 5,3 8 8. 23 Deductible rental real estate loss. e Caution:Your rental rRa1 ostata loss on • r line 22 may be limited.See page E-3 to Ws find out if you must file Form 6582,Real estate professionals must complete line :. 42 on page 2...................... 1 23 ) 24 Income.Add positive,amounts shown on line 22. Do not Include any losses ..... .......... ...... 24 5,388. 25 Losses.Add royalty losses from line 22 and rental real estate losses from line 23,Enter total losses here....... 25 0.) 26 Total rental real estate and royalty income or(lose),Combine.lines 24 and 25.Enter the result here.If Parts 11,111, IV,and fine 39 on page 2 do not apply to you,also enter this amount on Form 1041),line 17.Otherwise,Include , ? 1 this amount in the total on-fine 40 on page 2.. ' 26 5 3 8 8 . For Paperwork Reduction Act Notice,see Form 1040 Inst. CAA g E1 NTF 1s95oA Preparers Edition Schedule E(Form 1040)195s .. R SCHEDULE E Supplemental Income and Doss OMB No.1545.0074 (Form 1040) (From rental real estate,royalties,partnerships, �V O S corporations,estates,trusts,REMICs,etc) 20 Department of the Treasury ► Attach to Form 1040,1040NR,or Form 1041., Attachment Internal Revenue Service (99) See Instructions for Schedule E(Form 1040). sequence No. 1 Nsme(s)shown on return ���' Income or Loss From Rental Real Estate and Royalties Note,If you are in the business of renting personal property,use Schedule C or C-EZ(sea instructions).If you are an individual,report farm rental income or loss from Form 4835 on page 2,line 40. 1 List the type and address of each rental real estate roe 2 For each rental real estate Yes No A RESIDENTIAL RENTAL 100.00% property listed on line 1,did you or your family use it during the 15 OLD SHOR1; ROAD COT[1IT, b5A 02635 tax yearfor personal purposes A X g _ for more than the greater of: -------=-------- ---- •14days,or-- B . —______ —————.— •10°10 of the total days C _ rented at fair rental value? (See instructions.) - C Properties Totals Income: A B ` C Add columns A, B and C. 3 Rents received ....................... 3 9, 000, 3 9 000. 4 Royalties received .................... 4 4 Expenses: �N' 5 Advertising..................... 5 ti 6 Auto and travel (see instructions) 6 7 Cleaning and maintenance ........... 7 2,893 8 Commissions .........•,,. .:..... 8 9 Insurance .... ,•„ .. 9 1,475. 10 Legal and other professional fees ..... 10 11 Management fees .................... 11 12 Mortgage interest paid to banks, etc (see instructions) ........... .............. 12 12 ! 13 Other interest ............. . ... 13 y K , 14 Repairs.•...................•........ 14 1 15 Supplies .• ......................... 15 A�'\k X-a Its s��ia 16 Taxes ..................•,.......... 16 2 840. 17 Utilities ....................... .... 17 1,3 21. wi'+'t 18 Other(list) ---------------------- arty Q ---------------------- ———— - —————————— — 1? t 18 -----__.-------------- ————————————————————— ————————————————————— - 47r bra.: �.` —————————————— —————— 19 Add lines 5 through 18 ................ 19 8,525. 19 8,525. 20 Depreciation expense or depletion I (see instructions) ,.•.................. 20 180. 20 180. 21 Total expenses.Add lines 19 and 20 ,,• 21 8,705 nt ?•a`I' 22 Income or(loss)from rental real estate or '(",^` royalty properties.Subtract line 21 from line 3 rents or line 4(royalties).If the result is a (loss),see instruction to find out if you must 1�Cw,IA. file Form 6198 ......................•.. 22 295. " frc ;,+•+ . 23 Deductible rental real estate loss, )� tt. . Caution.Your rental real estate loss on line 22 '� { may be limited.See instructions to find out if you to Y d must file Form 8582.Real estate professionals must complete line 43 on page 2 .......... 23 1 24 Income,Add positive amounts shown on line 22.Do not include any losses.................................... 24 295, j 27 Losses,Add royalty losses from line z2 and rental real ealatc losses from line 23. tenter total losses hero ,;, 25 26 Total rental real estate and royalty income or(loss), Combine lines z4 and 25.Enter the I result here.,If Parts'II,ill,IV,and Ilne 40 on.page 2 do not apply to you,also enter this I amount on Form 1040,line 17,or Form 104ONR,line 18.Otherwise,include this amount j in the total on line 41 on page 2 „, ...... ...... 26, 295. (( BAA For Paperwork Reduction Act Notice,see instructions. FD122201 11108/09 Schedule E(Form 1040)2002 - I sCHEDULIZ E Supplemental Income and Loss oMervo.IW-0074 (Form 104b) (From rental real estate,royalties,partnerships, �� S corporations,estates,trusts,REMICs,etc) oe artment of the Treasury r Attach to Form 1040 1040NR,or Form 1041. Intemel Revenue Service ry (99) r See Instructions farchedule E(Form lbdb). s que cenNo. 13 Name(s)shown on return income or Loss From Rental Real Estate and Royalties Note.If you are in the business of renting personal property,use Schedule C or C-EZ(see instructions).If you are an individual,report farm rental income or loss from Form 4835 on page 2,line 40- 1 List the type and address of each rental real estate property: 2 far each rental real estate Yes j No A RESIDENTIAL RENTAL 10_0_._00% propel listed on line 1,did you or your family use It during the 15 OLD SRE ROAD -T - COTUIT- MA 02635 tax year for personal purposes A X B for more than the greater at -------------��- •lddays,or � •10 of the total days B c rented at fair rental value? •- --- ------ ----------------- ------------ • (Sae instructions.) I 0 Properties Totals Income: A S C Add columns A,S,and C. 3 Rents received 3 91 000. 3 9,000. 4 Royalties received. 4 4 Expenses: 5 Advertising.. ........... ...... 5 6 Auto and travel(see instructions),..,. 6 7 Cleaning and maintenance.,, ....... 7 900. 8 Commissions ........... ........... 8 i"S)s 7 9 Insurance..., .,, 9 1,248, 10 ....Legal and other professional fees. 10 11 Management fees .................... 11 12 Mortgage interest paid to banks, etc 1. (see instructions)..................... 12 12 2 13 Other interest ........................ 13 I 14 Repairs......... .......... 14 15 Supplies..................... 15 Y. 16 Taxes ............... .., .......... 16 3,327. . 17 Utilities ..... .............. ...... 17 924. r. ; 18 Other(list)�__ ---- --- iG° —————————————— -- — I --—————--- ————— `` ---------------------- - - -----��- ------------ --------------------- ---------------- ---- 19 Add lines 5 through 18. .............. 19 6,399. 19 6,399. 20 Depreciation expense or depletion (see instructions)..................... 20 255. 20 255. l 21 Total expenses.Add lines 19 and 20... 21 6 654 22 Income or(loss)from rental real estate or z...:% f royalty properties.Subtract line 21 from line 3 (rents)or line 4(royalties).If the result is a (loss),see instructions to find out if you must. 45__i7P file Form 619& ............. .... 22 2,346. 23 Deductible rental real estate loss. Caution.Your rental real estate loss on line 22 may be limited.See instructions to find out if you ? + must file Form 8582,Real estate professionals must complete line 43 on page 2 .........,. 23 24 Income.Add positive amounts shown on line 22, Do not include any losses...........:.:.................. 24 2,346. 25 Losses.Add royalty losses from line 22 and rental real.estate losses from line 23. Enter total losses here.... 25 I 26 Total rental real estate and royalty income or(loss).Combine lines 24 and 25.Enter the result here.If Parts II,III,IV,and line 40 on page 2 do not apply to you,also enter this amount on Form 1040,line 17,or form 1040NR.line 18-Otherwise,include this amount in the total on line 41 on page 2 ........................1,,....1.... 26 2, 346. i SAA For Paperwork Reduction Act Notice,see your tax return instructions. FDIZ2301 OGM110 Schedule E(Form 1040)2010 t l I f MA Schedule EIi1 fl li111 �fflfi11 fflfIlil FIRST NAME MIDDLE INITIAL LASTNAME Enclose copy of U.S.Schedule E and U.S.form aS62,Add Sch.E,Pert I,Ilnv 5;Part 11,tine o;and Part Ill,line 1 Enterrozuttin Form t,line 7 or Form 1—NR/Py,fine 9. Schedule E. Part I: Rental, Royalty and REMIC Income or Loss 1995 1a. Rental and royalty Income or loss(from U.S.Sch.F,Part I,line 26 and U.S,Soh-E,Part V,line 39) 18 5199. 00. 1b. Real Estate Mortgage Investment Conduit(REMIC)Income/loss(from U.S.Sch.E,Part.IV,line as) 1b 1. Subtotal.Combine tine 1a and line i b 1 5199. 00 2. Massachusetts differences,explain: 2 3_ Subtotal.Combine line 1 and line 2 3.. 5199. 00 i I 4. Abandoned Building Renovation Deduction(enclose statement--see instructions) 4 I 5. Total rental,royalty and REMIC income or loss for Mass,Subtract line 4 from line 3 5 .5199.0 0 Sohedule E. Part H: Income or Loss from Partnerships and S Corporations I. Partnership and S corporation income or lose(from U.S.Schedule E,Part 11,line 31) 1 2. Massachusetts differences,explain: 2 3. subtotal.Combine line 7 and line z 3 4. Abandoned Building Renovation Deduction(enclose statement--see Instructions) 4 5. Massachusetts adjusted partnership and S corporation Income or loss,Subtract line 4 from line 3 5 6. 12%lnterest and dividends in line 5(for Massachusetts Schedule,0,line 3) 16 7. Interest from Massachusetts banks included in line 5(for Form i,line 5a or Form-1-NR/PY,line 7a): 7 I 8. Subtotal,Add line B and line 7 '8 . 9. Total Income or loss from partnerships and S corporations.Subtract line 8 from line 5 $ Schedule E. Part III: Income or Loss from Grantor-typo Trusts and Non-Mass. Estates and Trusts 1. Estate and trust income or loss(from U,S.Schedule E,Pan Ill,line 36) 1 2. Masaachusetts differences,explain: 2 3. Subtotal,Combine line 1 and line 2 3 ! {t 4. Abandoned Building Renovation Deduction(enclose statement--see Instructions) 4 l I S. Massachusetts adjusted trust and estate income or loss.Subtract line 4 from line 3 5 ti. Estate or nongrantor-type trust income taxed on Massachusetts Form 2,if included In line 5 fi 7. Grantor-type trust and non-Massachusetts estate and trust income.Subtract line 6 from line 5 7- 8. 12%interest and dividends In line 7(for Massachusetts Schedule B,line 3) $ 9. Adjustments of 5,95%income(enclose statement) 9 I 10. Subtotal.Combine line 8 and line 9 10 { , 11. Income or'losa from grantor-type trusts&non-Mass.@States&trusts.Subtract line 10 from fine 7 11 MAE1 NTF 7222 Copyright Forms software only,19BB Nalco,Inc. N96MASEt �"' 1111�I{��u�w'�I�{k��(k+�kwkip�ti�i�l4���h�►4f�rlf�R�+tti'Y��f�N��if III . 2008 Schedule E, page 2 MA0801351030 Income or Loss from Partnerships and S Corporations 25 Passive loss allowed 25 26 Passive income 26 27 Non-passive loss 27 28 Section 179 expense deduction 28., 29 Non passive income 29 30 Combine lines 26 and 29 30 31 Combine.lines 25, 27 and 28 31 • I 32 Partnership and S corporation income or loss.Combine lines 30 and 31 $2. 0 33 Interest(other than MA banks)and dividends if included in line 32 33 0 34 Interest from Massachusetts banks if included in line 32 34 0 35 Total income or loss from partnerships and S corporations 35 0 ; Income or Loss from Estates and Trusts 36 Passive deduction or loss allowed 36 37 Passive income 37 . f 38 Non-passive deduction or loss 38 39 Non passive other income 39 . 40 Add lines 37 and 39 40 41 Add lines 36 and 38 ai 42 Estate and trust income or loss. Combine lines 40 and 41 42 0 - i 43 Estate or non-grantor-type trust income 43 0 44 Grantor-type trust and non-Massachusetts estate and trust income 44. '0 E 45 Interest and dividends if included in line 44 45 0 j 46 Adjustments to 5.3%income 46 0 I! 47 Subtotal. Combine lines 45 and 46 47 ' 0 48 Income or loss from grantor type and non-Mass estates and trusts 48 .. 0 Income or Loss from REMICs 49 Excess inclusion 49 50 Taxable income or loss 50 0 51 Income 51 I 52 Combine lines 50 and 51 52 i Farm Income I 53 Net farm rental income or loss 53 Summary 54 Income or loss.Combine lines 24,35,48,52 and 53 54 295 55 Massachusetts differences. Enclose statement 55 56 Abandoned building renovation deduction 56. 57 Total income or loss.Combine lines 54,55 and 56 57 295 I 03/21/2009 02 :37 PM 1030 MAIA0104 01=09 r fill 01.1810l.kNd( GL�{� .X3'l r�► :4, ►�r�114� fed'1 ���I� 2008 Schedule E MA0801341030 v NANCY J GRANT Income or Loss from Real Estate and Royalties Income 9000 1 Rents received 1„ 2 Royalties received .2 Expenses 3 Advartising 3 4 Auto and travel 4 5 Cleaning and maintenance 5 2893 6 Commissions 6 7 Insurance 7 1475 8 Legal and other professional fees 8 9 Management fees 9 10 Mortgage interest paid to banks,etc 10 11 Other interest 11 12 Repairs 12 196 13 Supplies 13 14 Taxes 14 2840 15 Utilities 1y 1121 16 Other expenses 16 17 Add lines 3 through 16 17 8525 18 Depreciation oxpense or depletion 1s 180 19 Total expenses.Add lines 17 and 18 19 . 8705 20 Income or loss from rental real estate or royalty properties. 2.0 295 21 Deductinle rental real estate loss 21 22 Income. Enter positive amounts shown on line 20 22 295 23 Losses,Add royalty losses from line 20 and real estate losses from line 21 28 24 Rental real estate and royalty income or loss 24 295. 03/.21/2009 02 :37 PM 1030 MAIA0104 01122109 III1 ROSE�'� Nk.RI f NANd llIII -1 2010 Schedule E-1 MA1001311030 NANCY J GRANT RESIDENTIAT, RENTRL . MA 02635 15 OLD SHORE ROAD' . COTUIT Check one: X Real estate Royalty income or Loss from Real Estate and Royalties Income 9000 1 Rents received 1 2 Royalties received 2 Expenses 3 3 Advertising 4 4 Auto and travel 900 5 Cleaning and maintenance 5 Commissions 6 b 7 1248 7 Insurance 8 Legal and other professional fees $ 9 Management fees 9 10 Mortgage interest paid to banks, etc 10 11 Other interest 1Y 12 Repairs 12 13 Supplies 13 14 3327 14 Taxes 924 15 Utilities 15 16 Other expenses 16 17 Add lines 3 through 16 17 6399 18 Depreciation expense or depletion 1.8 255 6654 19 Total expenses.Add lines 17 and 1$ 19 2346 20 Income or loss from rental real estate or royalty properties 70 2 34 ` 21 21 Deductible rental real estate loss 2346 22 Income.Enter positive amounts shown on line 20 22' 23 Losses,Add royalty lasses from line 20 and real estate losses from line 21 23 24 Rental real estate and royalty income or loss - 24 2346 25 Was this rental property used by you or your family for more than,14 days or more than 10 percent of the total number of days that the property was rented at fair market value? Yes X No L 03/21/2011 09 :36 AM MAIA0701 0812W10 THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINALS) M A , �C(J / "- L DATA TOWN OF BARNSTABLE 'S BOARD OF HEALTH �� �J 2 � "(V�✓ ARTICLE II:MINIMUM STANDARDS FOR HUMAN HABITATIONILt^e/ Date Owner - Tenant Address Address` Compliance Remarks or Regulation# Yes No Recommendations 2. Kitchen Facilities - 3. Bathroom Facilities ° 4. Water Supply 5. Hot Water Facilities 6. Heating Facilities 7. Lighting and Electrical Facilities 8. Ventilation 9. Installation and Maintenance of Facilities 10. Curtailment of Service 11.- Space and Use •'l 12. Exits 13. Installation and Maintenance of Structural Elements 14. Insects and Rodents 15. Garbage and Rubbish Storage and Disposal f' 16. Sewage Disposal 17. Temporary Housing PART II 37. Placarding of Condemned Dwelling; ------- Removal of Occupants; Demolition Person(s) Interviewed Inspector �- If Public Building such as Store or Hotel/Motel specify here HOBBS&WARREN,INC. + SARAH F. ALGER, P.C. ATTORNEYS AT LAW CHRISTINE A. JENNESS FIVE PARKER ROAD•POST OFFICE BOX 449 OSTERVILLE,MASSACHUSETFS•02655 TELEPHONE:508A28-8594 FACSIMILE:508A20-3162 caj@sfapc.coni Y TWO SOUTH WATER STREET NANTUCKET,MASSACHUSETTS•02554 TELEPHONE:508-228-1118 FACSIMILE:508-228-8004 xR .��?s r .T. .w e's"C,�' t } t� � L d �i•: 1.. w '$'� ' •e, r .r:'0. I.i+?4 '-t .'r �' "'` a 7. y� _ ,+,C,^ri y iwa`� 4'�.ficd-:-ems f'SEv^'-- i`,�,i L• 4'"" •7,�� a,a�, a -�iR+ t`�5 `�4 y.� COMMONWEALTH DEPARTMENT OF PUBLIC SAFETY ' t - OF 1010 COMMONWEALTH AVE, ; BOSTON MASS.02216' MASSACHUSETTS LICEIVBE�� s 1 ! S. EXPIRATION DATE—' (1/j'7'7 C0NS7R„ SUf?ERV�$17F : �nsp`•t,�.�i� � i RESTRICTIONS 6 EFFECTIVE DATEfL� ,LIC 0' � N01'jE 10 F �s7 tr s r� ' /01/ 4t523� 5. TRACY D� PRA7 M , +,7 Y Sy ! V C _ - P C BOXr .06{ Tr , PHOTO(BLASTING OPR ONLY) FEE: MASHPE A2649 . h 3 ". � �. HEIGHT: ALI TIL SIGNED'By LICENSEE;AND STAMPED R SIGNATURE O E COM ERA �. xS ,k Tex e{ T a ��7 n_. THIS DOCUMENT MUST BE CARRIED ON THE PERSON OF SKiN�LIRE OF LICENSEE OTHERS-RIGHT THUMB PRINT THE HOLDER WHEN ENGA6 t ¢ st - �. ED'IN THIS OCCUPATION J/�'y ►(�ja[�}}�(iy Zj a `+- '° cial,,k;(`"a�-xa•°°"S "'t < .. 200M•2.87.81429 ✓ 'cY'(.zi F _ A!'1- I Nt3;4 A HAIR Xf SJF h- _.- x 4 K 1 2 i r 1� trY �r X s �w] • x r ryv�L.4:'. 4:T C y tl'� 1 P '�'*' t.,� T"l.tat '��''3'r�`�I`s XkFl wt`s✓+ ,G +gagyc ap-5,A G,�,, 4�Ib I .. .. F p rn 13 Y l.Ejf, 3+� �f I�• �Si a' iy agree►PAN- ' r I SIT ! _i. C,_�I�ti.� � �� � � ��� � • II . Al 1 I , i tI t 1 r 11 I ; I _ I � r + -� - -L1 l ' �� �• 's - C6TU I � 1 i ,1 77-1 , 1 , CDX s , ,. ' I I 1 i f + _ I S' ( L - .- 1 XV i I f t C'o Pfle� 'D FILL i 1 1 Assessor's offr&(1st Floor):map Q y a THE Assessor's map and lot numb SEPTIC SYSTEM MUST BE er 3 S } INSTALLED IN COMPLIAN `�� T'`• Board of Health (3rd floor): a Sewage'Permit number —��^�� Ww eJ Engineering Department(3rd floor): —%J ENVMA ENTAL C®DE: ,'`t; �TA LL House number To a?n a•""��'•'' oo�1639. Definitive Plan.Approved by Planning Board 19 _ on C� -:,�• �► °� APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2:00 P.M.only sig�.�; , TOWN : OF : BARNST BLE Dat@ BU DING INSPECTOR APPLICATION FOR PERMIT TO F✓ �i ( ��v TYPE OF CONSTRUCTION A/MW Lje�,L QzS_4Lf5-- 19 ` r TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for permit according to the following information: s sty Location lea Proposed Use Zoning District /PF Fire DistrictV Name of Owner 'V AddreZ(JV J '6xf 4W &�l A-�7 Name of Builder /�/� �'1 "1 Address Name of Architect Address Number of Rooms / Foundation 0 Exterior Roofing 2 Floors l� J [� Interior Heating �— Plumbing Fireplace Approximate Costs G� Area 7, - �� o v Diagram of Lot and Building with Dimensions Fee >40' . l > 3_ t J� OCCUPANCY PERMITS REQUIRE NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barn a regar ing the above construction. Name Construction Supervisor's License t✓���� ' GRANT, NANCY f ` i°No 34578 Permit For Build Garage m Accgssory to Dwelling Location 15 Old Shore Road Cotuit ' y Owner- Nancy Grant r i � Frame .-•- - - . Type of, Plot Lot ' z 19 91,September 18- Permit Granted P . .i ' Date of Inspection ' 19 '' ~ ,x Date,Corripleted 19 M p� A 4Cr Q r FE ceot9 ° i :f _" _ _.,� :,; ,:__ _:... _ ,. ... .__; ..mrs.r.••�.rvi�T.-+w•C�.A•b;w.„,-{vK"�'^'.,'?+^'^'i.;o _ _ _ _ _... _ •7 w�,r.✓.t,.,^y..e,r,,,Fr.,s' .,Nn•,yr'k�`+•w��.""vrrriet�il�+'9y.•4tJSf'/+-ire,.-""16iy+/",r1+,.r.'A#:.i�* ".�.,`�" _. �^nr - ar?9�' d'vd""Yi Assessor's office(1st Floor); 3 S Assessor's map and lot number d d I 1�/n"�- Q�o�T"E To`` Board of Health(34 floor): r,W wr Sewage Permit number -- I�^ / ^� • Engineering Department(3rd floor): = Dsaa9Tsntt S riva �p House number, 1639. Definitive Plan,Approved by`Plannmg Board 1.9 APPLICATIONS PROCESSi=D 810-9:30 A.M.and 1:00-2:00 P.M.only, a q TOWN ., OF BARNST B L EE BULLDING INSPECTOR APPLICATION FOR PERMIT To TYPE OF CONSTRUCTION 6e4 lh' C/,( C.wn L J el L a-f ry f VY z 19 / l TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for permit according to the following information: Location g / PP y�� �'� ` Proposed Use Zoning.District Fire District / D r day Name of Owner ,�,Vr `� Addres L(Jr0" J �!'xf 4r,-( �p D /� 1 Name of Builder '/ /� � Address P J � 1 !i Name of Architect Address / l Number of Room 's .( Foundation Exterior C Roofing K 1 Floors C r J �-'l� Interior Heating '- ;`, Plumbing - • g Fireplace `" — Approximate Costl � -4 Area CJ { Diagram of Lot and Building with Dimensions \ Fee � - I V/122 3a" j i 1 + OCCUPANCY PERMITS REQUIRE F NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barret a regar ing the above construction. J Name ti 'N. rI `Construction Supervisor's License a GRANT',- NA = -074 c rS No 34578 Permit For B ild Gara Accessory to Dwelling Location 15 Old Shore Road Cotuit Owner Nancy Grant Type of Construction F-r-a-me Plot Lot Permit Granted September 18 , 19 91' _ Date of Inspection 19 Date Completed 19 r i 1 .. 1 I 01v�£SelJ:-' � 47J.Q� .• � � J�4 =- � _ a __�.1S�IE-:_. - i Ip kK � 10 e -FEZ � _ I _ F.tY _��icAl� IILL11 t rr.2r>s�t� it ' � I• 'TTS'� �-__ Ic�g]'�C'SrJL4FC N � � - - �- ---- W _ ' }t x .....-- I - - --`— --_... -- -- -.. - ''.... --- ... - - -411 i : C I — fl �' C I - p tweaor�cu.c rb.8�anpr,NG — CL-lANtO/ZTI'CTN=P A-- I - . - _ .:r. : .. - •tzSStg� Jcpt � " Bruce Devlin,.,..,. pesign® 774.238-0773. r _ 3 r *OK i I ':'�Rpp�et.,�si.� ,ocw v/ tni _ - - - pli xcrsaf�s��F3.fwncu _ IT y !l ry 'G{ I O I .._. r7r ._ 1 I - K=D -�'1Z [-fc�uc�xtatxnw I 12 o {I _ _ XI�IX �tJ � - I I ♦ -I'I I I I t II I ?A36\"D : � ! TssL�— �-- klt\�CSG1Sb••-r �� N .� I � ,�� - _ M�t �tb�ie �t��, _ ' • E : t : i I" I 71... t 1 J I I ' I 1 , ra.5ra�rrlwa ,� C2U1�i[J�TIC7N`eLz-yW I � — .' I .I --- -- I i Bruce Devlin t ]assign® 774.23".773 t • S (r1 d BUILDING DEPT. AUG 12 2020 TOWN OF BARNSTABLE RTn 4e Vec.tc` . VV-C:U-"T�gERI NL` Uri EC�.vcL—�' -- --- RtTURN CU TFR rRo�. _pN�.._... ON TKV/EA' L 1 CJN is wen 7 � i �ci�se — i �D _- eos.crtow�.o•a t-n v, G-5-3oFs t-i . C;AV T_INCBF,RS.hc 5,r,NCt.S ICQVAI— r E= - I�I�I�I - �° ab-o un_4_ous 19 � �i ( �;( I �or�Eix..r�>✓.. i ( 1 COHGW W W(dl.,(Cjt,,,_ �,,��. .. �,� cuk—,A) - - - -- - ------...... Bruce Devlin Designs ©oPyright i . 1 sue:,. -- I,i I � N • ---"- 35 -- r —- 2xL1:R^` tse--.:�5/.T �, 61�G I I LLJ rre CUR,; —P ` � t5-'-r-- —'_.+.:^ IK8 t=.c 1c[.a " I 4G3�s r cx>n La _ ROOF 1 Fk A//, J 'tL 1 ail ; i � rl a i TOP xG I i y OON-M1ri/EK COR,L a _- sZtmS K":OC - . m Ji g �.. ..L SlLL �SL.CUcYi _•. t 1[_tl _ - � 5� ',. �� � � •i�/ �Q �2xlo�JSCS'lG^�r1 S1 "�OEJn 1 tCwR-ER�u \y ('I Vo- "ao) - jQ r h 0, l _ _0 a �) "c.Cz L�15 wj4x6 -- t O GO/AF4CT.. - 3.a-6"- oi,. i 1-1U_ — Q� ( F I 2 0 I GA `5-.��i_C "LO_) -EOUN)jA E.nN PLAN °4 �. • 5Ld"m/�IVCN CJP,A:fLCS'W�'S"n?"><t/4'•?U1G. _..__ _____ —_. ._ •.1 t...nL,�,CGt:c l:'.-LLe�SUp:6_'(vtsES. ft �ZiiQp 10 i-W M 1 INEM� �11 w�v�+ws 6a Glipc' - / - �r„�� `,. �#FOR�fb0��Ld tJ�1•ltiyWC.�t li won _ wrO�L7iA� ` 1!K>mwm tams fY � �R 12AffL�Y •�1l�IiM�MMLLi 0 ./lpl�faf ! � � �:Jf.tflf ! IF mosm =41Mal LS mitt a"' s � iv'I .. s �,f IC{tpd�T10M - or�i�d�firtf �! war � ti. WIt 4 AVANDRAM TO rwwao�rlY nma�IMMAerrtt�lrwRlrf ilt rA"S. WALL OP�N1FKs8 - eriaw�■ao..�rru s" �� t �_`�Q K i r� sasi w ti------�------ aaxr�aww�+war-r :-•.'-""�'asr� �fld+arr�L *W rn Arw ron wow _ .•a-�.-. .+a.• '.•�.:•..��•:•w•• _ - ft1L���ta�Ailtmeorli�r+�tw�xfPanbarrl0SlrCtA�1.. - - " ,sue a tt'•X+ :�� isiaa�►� AIL .. O_Rt1..-aL i ..•.:/+.i•.A.F w W" a,:N nKiP igfipR�RM�YR4.Ar11_.� . i •L•yy••t• AAi� d�If t� -�Ss•st•�LtaN AA=Mi Ya rS)+o llp4YrNR1YA>��M4�fji •�a"- _ dr *ANN �� �ii wa S�S�i�Stf tia'♦Ai -- .'d�.•ry ••t. - rtOi v ~ A.�w•I♦:N�R. •A.Ir.A:A r . ��9b t.7�f"L -..,.r._... r �• •'•r: r f;f ommumm.....r —RJse i�l�..Yl�i�f I�_�1 ener R iR0 .'•♦.�ls�M�N�A�A.♦7•GIs�A.• I '.!•'r f.��'r St,4 4.1 WALLS MWWAN rY ..YfYM„'.fr4l' MYL no al" dYb/M>7Mfrt�E vuo4•y- war 4i IDt�WLLe - AtD 1�AOER6 »*cam rat rrwr. :•_•_=---- »•—OL R��, i �_•`�y M& I - m f�,Md, i�.• �Ri�llr. 011�ittrwi _ _-- _- - r r:r r'•+M yrotY! �.�•t�{�N�i'`�ryrn /rw -'� -ai�R�.� wo-DAMPTAWA 1 M• rlmm�op •�N• } I T.i.f ���y �tGA- Y f�M y.. ..iafMLlr. •.'� MI�raON i!//Y...��Mlir _ a .YF1s •r••q N�•M N ril`� : wo�ir>b eRscM�r saa near +¢Aoreao :fv r:: :•a ��sa� ww...�—uwwtrra�crc�u.q �p� 1D 8» !AbO 24" CAOI RO �} a M r 7: Srpsf w+w--- 17 C+ML 13 4arML FLARA/ IIAR:bYlalii Iid lid AT.illf �• �"ti"'« �11LOI�IO �iMLQ�li� 0/�tO��f ��q� �7 `r r O�ms� - 11fA I. lfid- >rQAI a•+`''� �SpIrIR ..Itii - ASS.dMwrr�_ >�>O � i O-�A►A11ia8iS �� c�wrr�iSuoX rl.tA4ir me�>O ��.�g mcaa. gearar� +ems r safr raw nwr •.'r•'` WA seSw ilfRSSt 1pA�MafAivsMR ■07,0�iiID 24d sad iAci[�7 �=r-f•' +w�cawrr<«wr�. rwit� x�iRrvtliursa�w► _!L A.pCSi�N 7p Tpir tarNL d10ialAt�! - 7�.lw 4" CAM/SACK ti• •.•..' ttSrf o AR 1O04PJMW IiA1� To A14� !� f#d iACAAf •jr•ii�. .:.' Ytl r�If�OMCM _40" 1 �TQNLM liS1A1■C, 3•�i . 24" rl iiT : .aJ•: vfq iwccmm 1 - i01YLrrti . 7. MO JMWTA OUOW1tmf 34W 4Y/ !ice •i'•:•. ••'f •�•-•AAa r~�Ci ~ RASSi101f --� tSMOADMI�O 9'17.vfSO6MN1fi�N f+7is sia »�T- _ - :- • YiYI m1�-- --- i 1. �''f• N7RNtr01CPA� .+ 1 1„�M 1_-}l••� C/IOIrYS•r:�A4 LJ SQMN.MWAPTA LOI Q'dity -e - { ieAt as osAGp'�isNOcc=- 00. _ - �as - r�S/r/00 �• ~?• iF�fYeM� etASRaafiSlts!!�r i lracop once s ac ft m 4•�r i'nao � %_C.'s io rla - toceuf o � i sAre aolia.faRYtMo* w os ret*slu�fc+ap '_'.• rOs ye►osrAo4/�aUnNi,eSwstr{. - a ! ZAAsW aswwaAsr w W trWW'drein _ �'wtf cnw�ar+• . sAoddat rarrwsrsracrlrrf�1rsA1Rf""""'•' # . .MOr MIS C!AAIIR lqA e! - 1W O MM r a'Slip s�I•. r A. fNrP 1C11 rIo •�- - ••'- -- =----` rypgSpO �• • ti.♦ sa�IOOF'if �J� - - •� ♦�. •A. ar/eCRR4riAlad�lCiOlOI�tt r rNSla0. t sleets..7[. i/faOtwo '♦ttfOtR/�JrO- _ • '�7I OA. �♦r1•y • ♦ _Ms 711� •nft 7POii/MIRS O01rOm1i/0fi0�Ri•�C " �� I - t i +i.1`t •• ;as: LY�t-- co�NOslr - �.5._AL ' ! !• ' .jl Kea t!•4 �_ l�RA1--�-- °-. _ �,�[ f77ii1•• • •J(, ow r wow r r tvf • ..'ti►' Ay tsL- •�, ttrAR..•. . totttRa. - _ ���• e Ss le l� • S �t SO�trIM00��10S�FOOLSNtiillDl�iYlOr W ewe" MrAft �M1rs W l��,aP�p +A!�- :A: MlrlfAlgelOAt�i�t war ,ItwtlYit4/lONJs , tM i1M'Mt R/CAOti - �t�r - - �AI��R� rCSR laxamm . 1RAM 8WL st1�F�°JGi�T��A�� �alwotsao.oew�e m�ir�rl rtnLml M tfd r�fi,rom* 10�MI�fir1 .......-.--r.-..�• l iR �MAIO4Ip► AttflilSt>aMif tos t>r r ,.r,na GEI11i A1�D 114 weiarnre�ern xfrovaw�_� MLW4 ' Bruce Devlin Designs ' x_774- 2.7• 6627