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0082 PINE RIDGE ROAD
82 �NE�����r�� J t +1 LbTs 4& 4 17 f., sT1�G LOT 45 U fi::)rJ0DAPO.l 0 LOT 48 f ` = 31 - x:r k' m M - 80.0 i I PREPARED FOR (ZOVIJF-y t7A 50 rw CEERTIRE'D PL O T PL AN ' LOCATION GoTy 1T ` SCALE: I - �o° DA TE � � In I�x - ace REFERENCE: LOT-5 4(p 47 ' P. B. 2h P. 73 L.C. P. FLOOD ZONE c or / HEREBY CERTIFY THAT THE BUILDING GE°R , ' • t SHOWN ON THIS PLAN /S LOCATED ON THE o7 o GROUND AS SHOWN HEREON AND THAT IT �' CS CONFORM TO THE ZONING BY-LAWS OF THE TOWN OF SA12dS-TABL F- s '16�•��jr� . WHEN CONSTRUCTED. LOW & WEL L ER, INC. r� 7/4 MAINS TREE T YARMOUTH, MASS. DA TE _Town of Barnstable BUlldln 77!7 � �., g rnir�rar3i� Post This°Card So That'itis VisibWFrorr>ahelStreet Approved Plans'Must be Retained on-Job,an'd this Card Must be Kept 6' �� Posted Until Final,lnspection Has Been Made: iW_.here a Ce;rtificate`ofOccupancy is Required,such Biaildingahall Not be Occupied until a`Finalanspection has been;matle. Permit Permit No. B-19-122 Applicant Name: Arminas Dimsa Approvals Date Issued: 01/14/2019 Current Use: Structure Permit Type: Building-Siding/Windows/Roof/Doors Expiration Date: 07/14/2019 Foundation: Location: 82 PINE RIDGE ROAD,COTUIT Map/Lot. 018 017 _ Zoning District: RF Sheathing: Owner on Record: LIZDENIS, RICHARD M&CAROLYN Contractor Name. ARMINAS DLMSA Framing: 1 Address: 1001 VIA Vf NTANA Contractor License CS=093566 2 PALOS VER'DES EST,CA 90274 Est. Project Cost: $3,000.00 Chimney: Description: Reroof porch only Perm it,'Fee: $35.00 Insulation: Project Review Req: Fee Paid, $35.00 JI x. Date: f'g 1/14/2019 Final: a _ Plumbing/Gas Rough Plumbing: g g °.Building Official Final Plumbing: i months r.issuance.�' i�. with n six mo t s afte This I invalid unless h work authorized his permit s commenced .permit sha I be deemed abandoned and a d u ess the o ,auto ed by t, p ;. � -- � Rough Gas. All work authorized by this permit.shall conform-to the approved application and the'approved construction documents for which this permit has been granted. All construction,alterations and changes of use of any building and structures s,hall be in compliance with the local zoning by-laws and codes. Final Gas: This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for,public inspection for the entire duration of the work until the completion of the same. '- - -- ° Electrical The Certificate of Occupancy will not be issued until all applicable signatures by the"Building and Fire.Officials are provided on this permit. Service: Minimum of Five Call Inspections Required for All Construction Work r"} 1.Foundation or Footing ( Rough: 2.Sheathing Inspection "' '""" -`i':. 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Final: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection 5.Prior to.Covering Structural Members(Frame Inspection) Low Voltage Rough: 6.Insulation 7.Final Inspection before Occupancy Low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Persons contracting,with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Fire Department Building plans are to be available on site Final: All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT J Town of Barnstable *Permit Regulatory Services wee 6 n romissuedat sextvsTeste, v nsass. Richard V.Scali,Director 059. �ArFD MA't A�0 Building Division Paul Roma,Building Commissioner' , 200 Main Street,Hyannis,MA 02601 www.town.bamstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint ' Map/parcel Number Property Address P,�,,e- Cdbl+ [Residential Value of Work$ 000 � Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address P id el-&dyAI o L Telephone Number ' o�c� 'O$7pe Contractor's Name keQ�&) ��i2 (,IC p 3 y- Home.Improvement Contractor License#(if applicable) /9?6 7 Email: ,eL C°Afr �N Construction Supervisor's License#(if applicable) �S ' oq7 ❑Workman's Compensation Insurance Che k one: I am a sole proprietor �j) "'�! I am the Homeowner Oki O� ❑ . I have Worker's Compensation Insurance A '� , Insurance Company Name ' 6 Workman's Comp.Policy# . Copy of Insurance Compliance Certificate must accompany each permit. l� Permit Request(check box) //' ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to L/d ron ,'l ❑Re-roof(hurricane nailed)(not stripping. Going over exist layers layers of roof) El Re-sideSr14 e'"146 f;,>" ✓ p Replacement Windows/doors/sliders.;U-Value Or (maximum.32)#of windows d #of doors: / ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is required. SIGNATURE: Q:\WPFILES\FORMS\building permit forms\EXPRESS.doC , 06/20/16 T7ze CQar=omvea th afMassadj--=etfs Department a,f ruihrrdr sfriat Accidents Offixe of rnTesli ins. - 600 Washfizgion Street r •- -- Baston,MA 0211 frpvtr�.mcrss:�av�rfiri . . • . � Workers' Canipensafian.Iusnxazce A fidaviL BuzWrs/Ciantractar Mectricians/P'hmihers AppFcant Warinatian Please Prim F y Naaffie4B �1`r2='CI� �Dn/ S`1Y-yc4Ir0►' 77 tee: fllaebc 9 Rio J22tVt 5,4 orr A4o y Are you an emplayerTICheck the appropriate box: Type of project(required}: El 4 I am.a general contm ❑ 6.ator and I employees(fish an&or part-time * have hired the salt-contractors New oonsi�c� 2.❑ I am a sale proprietor orp3rtner- listed on the attached sheet 7. P6 Remodeling :.._ ship and have no employees These sub-condractars have 9- Demolition 10 andhavewo&ers' wading farts in any Mfg_ � �. 9..�Buil�adxiifiou [Na WO&M(g'comp_insurance camp.insurance--I required-] 5. ❑ We are a corporatica and its 10-0 Electrical repairs or a,dd5tions 3.❑ I ams.a homeoumer doing all wove officers haveexercised their 11-0 Plambingrepairs or addititms myself[No warl='comp- �t of emempfinn§1 and we r M(no 13.Qf Reaofregairs _ insurance req�ed.)Y i3-E]other employees.(No wmk= comp-immnance required.] �$a[y apgEics e5at ched mhos in tmost slsa i�outthe sectiaabeTaa' lug ti�rswodces'cmap��+fi�paycgiaingmaurnL #ffameoaiaers�o sa6�t his�5daci{in g they aze daiag 81E vrn¢Y Sad theC I3FIE autsi�e CO�L�@S�St Submit a neW affid Cmdiamng such ZCaaLrs cam OR itehecktldsbtucmustrftchens.addiiions�slxeetshoic�theaameofthes¢b-cnmdtscros�dstye�rhetftetarnotf6nseen3itieshaRe aVloyem.IfthesnV-cantxctctshmempIai-ee%dLeymmstpmr-i&thek vurhrx*,'cmmp•PG&FavmbLLr_ I acre an euiplayer thatis prm idirrg yvrlrkers'car tsrdian utsrirance far my emp&)ves Setoev is YihRpvM7 and1ola site infotTr atiDlL Iasuraace Company Name: Pffficy 44 or Self-ins.Uc_ E�piratioaDafe: Job Site.Address: CitVIState/zip: - Attach a-copy of the work-ere compensa tionpoli6y declaration page(showing the policy number and expo ation date). Failure to secure coverage as required under Sack( r 25A of MGL.c.15-7 can lead to the imposition of criminal penalties of a' flue up to$1,50D Da aadlar oae:yearimprism=mnf,$s well asrivd penalties im the fans of a STOP WORK ORDERand a frme of up-to$25100 a day against the violator. Be adsdsed'fhat a copy of this statement maybe forwarded to the Office of w iffv stigations office DIA for insurance coverage tiedfitation. T do TWMl y cstizfj�as eke paints and mnabVes a.freer}'tlratfJra iafbrrsw#iart prmd aboe�a is trzrg mid correct Sit�attsre: Date: 0jo7ciat use only, 3Jo seat writs in flib aria,to 5e arrupTeted 1,p dt y artopm ojoY aL _ a City or T'otivw Permit tense:ff Lssaing Auf1writy(title one): L Board of Il ealth I Bmildin Department 3.fit Town Clerk 4 Electrical Faspector S.Phmmbing Empector C.other Coetet Person Phone#- lbaformation and Instructions Mas=a efts C•►=mg Laws ffiVb=M requires all employ=to provide w015M&compensation for thou-employees- ned ash.evmypersanm$fe service of any coact afbae, Prn sr to this mute,as�layee is defi =T=ss or iiuplit oral or ." An MIP&yer is deed as"au m.dividnaL p=nership,associafiom,cmporaiion or other legal entity,or auly two or more of the foregoing engaged in a joint use,a How adinclndmgthe legal eseafafives of a deceased employer,or v the receiver or traatee of an mfividnal,pip,association or ofherlegal eaiitY,eozployng emxpinyees. ever the ow=of a•dwelling howo havmgnot mme t3�tlaee apa ctuamis andwho resides fiim-cio,ar the occopant Oft he- dweITmghorse of ano5ier who emzpIvys peis®s to do mami-enancc,rrnefrrirf;on"or repay��.on such dwelling house or on the grounds or bm7dmg aplsnatthereto shallnotbecanse of sash employmeutbe deemedtn be an employer." MCH.chapter I52,§25C{6)also st dcs that¢evay.stsfa or local licensing agencg shaII wif hold fhe issuance or renewal of a license or permit to operate a bur imess or to construct bUildings in the coffinonwealth for any applicanfw•ho.has notproduced acceptable eYideace of cnmpbanaetvith the"n,R„-ance covexageregnirecL Additionally,MC2 chapter M.§25C(7)sbirs¢Neitherthe mt? `nor a'ay of its political subdivisions shall . enter ink any contract for the penance ofpubIic wosic u�I acceptable'evidence of compliance with the msarance. reTo:ir= cots of tf=riaptcr have been preseaned to fhe M33t i�a aafiiozity" Applicants Please fEI out th-e wo&='compensation affidavit completely,by g La boxes that apply to your situation ancl,if necessary,supply s)name(s), address(es)and Phnnenumbet(s)along with their ceriificatate(s)of mn-a ce- Limited Liability Companies(LLC)or Limited Liability Partol�s-(LU)withnoemployees other i tlZe members or p are not rbgmred to cauy wmim-s'compeasatim ivasurance. If an LLC or LLP does have �pjoyees,a.policyisrmp red. BaadYisedtbatthisafhdaykmaybesnlsnhfe3totheDepartmentof ludus6.ial Accidents for con�on of fiMUM=cOYezage. Also be score to sign and date he a dayiE The of aYit shourld be rstumed to the city or town that f e,application for the permit or licenso is being requested,not the Depadment of ; Tiv�rtcfrial A=de Sho�uldyou have axcy r�rarctions regmdmg the I-m or ifyou aie regmredtn obtain a worio�s' compensation policy,please call the Deparim enf at the number listed below. Self-insured"companies should ear their self_n sM rt Hcrose number on the appropriafs line. City or Town Officials . f - Please be sure that the affidavit is complete and prbtt-,alegibly. The Department has provided a space at the:boffrm of the affidavit for you to:OH out in the event the Office ofInvert s to coactyouzregan ing e applicant Please be sure m fill in the permiOicemse nur-nber which wM be mi-,d as a'refereace number. Iu•addition,an applicant that Must suhmit m.UIfiPIe permitflic=se applitadcros in any given ye& neeA'only submit one affidavit fidiratmg cat policy mfo=ation.(if n ecessaq)and under"Job Site A_d.�ess"the applies should write"all loons i1 (may or town)_"A copy of the-affidmvitthat has b=a officially stamped or ma `by AAe.city or tuwa may be provided to the " applicant as yrooYt Ut a valid affidavit is on file for babz poem!or�_c= ,•s_ A new affidavit must be filled Olt each year-.'Where a home owner or citizen is obtaining a license or permit not related to any bn si„=or co"am" d VEatre ^ (-fie. a dog license or peunit to bum leaves etc)said person is NOT retlaared.to Mete taus affidavit The Office of lavesfig fi=would like to ifumlr you is advance fur your cocspeaaf a[L and shopld you have:any gaes ions, please do not hes7falz to give us a call. The DcRE5 =f S atidress,telephone and fax zmmbe� Cjan=LMWWM of Iassach De2artineat c6flidushiz1 Auden. . face�.f��fza� 61Q4 Ti n Stmet . Boston=MA 0211 T61.4 617-' 7-4 =t4€6 or 1-977 TEA SAS Fax it 617 727?749 Revise3 4 24-0.7 mass Wdi , CCOR01 CERTIFICATE OF LIABILITY INSURANCE ' DATE(MMIDD/YYYY) `� 1 11/28/2016 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(les)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Suzanne Harrington MURRAY&MACDONALD INSURANCE SERVICES, INC. PHONE (508)289-4170 FAAX /C No: noo ES • sharrington@mmisi.com 550 MACARTHUR BLVD. INSURERS AFFORDING COVERAGE NAIC# BOURNE MA 02532 INSURERA: TRAVELERS INDEMNITY CO OF AMERICA 25666 INSURED INSURER B NELSON DAVID INSURERC: INSURER D: - 84 BRAXTON RD INSURERE: EFALMOUTH MA 02536 1 INSURERF: COVERAGES CERTIFICATE NUMBER: 106212 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 EFF POLICY EXP LT POLICYNUMBER M D/YYYY1 (MM/DD1YYYY1 LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE OCCUR DAMAGE TOREN ED PRE ISES Ea occurrence $ MED EXP Any one person) $ N/A PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY 0 JECT LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident) ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS N/A BODILY INJURY(Per accident) $ HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS Per accitlen UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESSLIAB CLA"&MADE N/A AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION X STATUTE ERH AND EMPLOYERS'LIABILITY Y/N ANYPROPRIETOR/PARTNER/EXECUTIVE I E.L.EACH ACCIDENT $ 100,000 A OFFICERIMEMBEREXCLUDED? I WA WA WA 6HUB2E92731316 10/26/2016 10/26/2017 (Mandatory in NH) E.L.DISEASE-FA EMPLOYEE $ 100,000 If yes,desaibe under DESCRIPTION OF OPERATIONS below E.L DISEASE-POLICY LIMIT $ 500,000 N/A DESCRIPTION OF OPERATIONS/LOCATIONS/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 ff 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.gov/lwd/workers-compensation/investigations/. Sole proprietor has not elected coverage. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED_ IN Strlck Construction Services ACCORDANCE WITH THE POLICY PROVISIONS. 14 Harbor Ridge Drive - AUTHORIZED REPRESENTATIVE - Mashpee MA 02649 r CAS Daniel M.Cro r ey,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 *� i�/M{r•t+"may' i*!�• .�. •y... �...yl.-.ehl�aTr. ..is�v�...+..��mac..sl.aa�+M�Ne�NeA^F.�...:y....k - -.� .,. ,. }_� >n+-e. _.�..", ...rat_... � � '�',R • ti�.v n�a.T .}s'f` � ..:s'x•.�..�, �--�.��Y E A!'� .«r �• \�f�+ _ 7:;i�.�t'�;:�. T�r�i�i,,, ,. ,.�,.,. w r -�..ns .cr ks�•k:w..«.,,..s..u. >s;w-kt-,•,hs,u+�.,�5•rsxz,+�rt• � •- tv..::<m« . . ',\is- ,.-..«....wx�a�W ry of thclatpf"B,.�m�t�t" ",Pf ip Y3tiA 4.cp !�' ` S:x�"s r+ a2:aT �t'°;.� h+i.$C 'IY CC fi42` m21Li3E3 al5t� , �,. 471 , row rUl '4 Scanned by CarnScanner C9� �Pariv�rcoazcuecr� o�Goca��uQeGZa*. Office,of Con.sgrner'Affairs.&.Business Regulation HOME IMPROVEMENT.CONTRACTOR , b Registration.� $3572 TYpe. Expiratio 1012$2�1:7 Individual . t N. KEVIN STRICK a , KEVIN STRICK ♦ 14 HARBOR:'RIDGE DI�/E MASNREE,MA-0 2649 Undersecretary • - ® Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CS-094085 F' Const ruction Sup ervisor • P x i KEVIN B STRICK 14 HARBOR RIDGE DR MASHPEE MA 02649 - Expiration. u Commissioner 01/17/2618 ill ! 3 a • License or registration valid for individul-use only before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation I 10 Park Plaza, Suite 5170• a Boston,MA 02116 Not valid without signature Construction Supervisor Restricted to: use rou which contain Unrestricted-Buildings of any g. p.. less than 35,000 Cubic feet(991 cubic meters)of enclosed space. Failure to possess a current edition of the Massachusetts State Building Code is cause for revoca�ASSon ofGOVIDPSthis license W . DPS Licensing information visit: WW fi 'r TOWN OF BARNSTABLE BUILDING PERMIT-APPLICATION Map O� D Parcel n Application# ,- OC�(a0(0(.P Health Division Date Issued'Y vet Conservation Division Application Fee Tax Collector Permit Fee S7 Treasurer Planning Dept. Date Definitive Plan Approved by Planning Boardj�V� Historic-OKH Preservation/Hyannis Project Street Address Village Couk ; IFJ �j Owner j r7,,- t �r � L� Address Lf`�30 ttSl Ct I �i �-1, O2 Telephone a f u ( ay Permit Request I Z 12b0 r-" P�� Z�1� f CQ f a 4p 2 7ak--) PO E ZO T C21 4� +� r Square feet: 1st floor:existing 0D proposed 2nd floor:existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation[qO6a Construction Type ulyd> Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family M Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes dLNo On Old King's Highway: ❑Yes U(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_ 7 new Total Room Count(not including baths):existing new First Floor Room Count Heat Type and Fuel: ❑Gas Oil ❑ Electric ❑Other Central Air: ❑Yes %kNo Fireplaces: Existing New Existing wood/coal stove: ❑Yes &tNo Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage:W existing ❑new size Iu�Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes 55 No If yes, site plan review# Current Use Proposed Use BUILDER INFORMATION ; _ K Name llaa ����� Telephone Number Address 72 �C <<o S 7 JA( 5 l License# Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TOSS-L(�. yVP�l4� SIGNATUR DATE l FOR OFFICIAL USE ONLY P� APPLICATION# ` DATEISSUED MAP/PARCELNO. ADDRESS• VILLAGE OWNER .` DATE OF INSPECTION: ; FOUNDATION FRAME ' INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL s. FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. ti` ' The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,AM 02111, www.mass gov/dia ' Workers'Compensation Ilasurance Affidavit: Builders/Contractors/Elettridans/Plumbers Applicant Information Please Print Legibly Name(Business/Organization&dividualT�): EI tr�✓V Address: $S 7 Mo w City/State/zip: n u k Off( J5� Phone.#:EDS -t'1�s�c( Are you an employer?Check the appropriate boa: :Type of project(required)-. 1. I am a employe with 4. [] I am a general contractor and I emp Y 6. ❑New construction . ''employees(full artdlor time).*• have hired the sub-contractors • . 2.El I am a'sole proprietor or partner- on the-attached sheet. 7. ❑Remodeling ship and have no employees . These sub-contraciors have g, ❑Demolition'. working for me in any capacity. employees and have workers' 9 El Betiding addition [No workers' comp.insurance comp.insurance. ' required] 5. [] We are a corporation and its 10.[]Electrical repairs or additions officers have exercised their 11. Plumbin repairs or additions ' '3.❑ I am a homeowner doing all-work . ❑ g P myself(No workers' comp. right 6f exemption per MGL 12.(]Roof repairs insurance.required.]t c, 152, §1(4),and we have no employees.[No workers' 13.❑Other ' comp,insurance required] *Any applicant that checks box 01 must also fill out the section below showing their workers'compensation policy infmination. t Homeowncm. &o submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating'such tContmctors that check this box mutt attached an additional sheet showing the name of the sub-contractors and state whether ornot those entities have employees. if the sub-contractors have employees,1heymust providt their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below isthe policy and job site' information. Insurance Company NaYne: T n Policy#or Self-ins.Lic.A. an "C�CP O` Expiration Date: lob Site Address:9�L?/I P-(z(26 t City/State/Zip• <021 t ]` Attach a copy of the workers'compensation policy declaration page'(showing the policy number and expiration date). Failure•to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine tip to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK•ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the-Office of Investigations of the bIA for insurance coverage verification. ' I do hereby certify under the Lt ius- 0mald perjury that the information Providedlabovg is true and correct Sim ature Date: l _ Phone#• . c�R'q "[ �� Official use only. Do not write b7 this area, fo be completed by city or town,offcciaL City or Town: ' Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3,City/Town Clerk 4.Electrical Inspector_'S.Plumbing Inspector 6. Other Contact Person: Phone M Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of.an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such"employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall 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-contractor(s)name(s),address(es)and phone number(s) along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(UP)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 4bn file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should•you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: .The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 t - Tel. # 617-727-4900 ext 406 or 1477-MASSAFE Fax# 617-727-7749 Revised 11-22-06 www.mass.gov/dia SHE ray Town of Barnstable Regulatory Services SMMSTABLK MASS. 4 Thomas F.Geiler,Director AIE1639. Building Division Tom,Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-8624038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I,Jam( (�( ` � LZ pL Q-5 , as Owner of the subject property hereby authorize�1=rt2 t-� to act on my behalf, in all matters relative to work authorized by this building permit application for (Address of Job) T/ Signature of er Date Print Name ` If Property Owner is applying for permit please complete-the' Homeowners License Exemption Form on the reverse side. • a Q:FORMS:O WNERP ERMISS ION i Town of Barnstable THE r, Regulatory Services Thomas F.Geiler,Director BARNSfABLE. 9 MASS. g q,A 1639. pie Building Division rED � Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village ."HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code �i .. The current exemption for"homeowners"was extended to include owner-occupied dwellings of six uirits or less and. to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside, on which there is,or is intended to be, a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on'a form acceptable to the Building Official, that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions. of this section(Section 109.1.1 Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a fom-/certification for use in your community. Q:fon-ns:homeexempt 16:39 FAX 5084283068 GERX011 INSURANCE aool DATE(MMIDD It I III IN V.1 IN n 4 h 1114/2008 1 .41. Ev 1, AORz. x PRODUCER THIS CERTIFICATE 18 ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE GERMANI INSURANCE AGENCY HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 908 MAIN STREET ALTER THE COVERAGE AFFORDED BYTE POLICIES BELOW. OSTERVILLE,MA 02656 COMPANIES AFFORDING COVERAGE COMPANY A AIM MUTUAL INSURANCE COMPANY INSURED COMPANY PETER D.FIELD DBA PETER FIELD BUILDING&RESTORATION COMPANY PO Box 16 C COTU IT.MA 02635 COMPANY NEU,. A-106210-1111 PIKE 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 B Y 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. CO TYPE OF INSURANCE POLICY EFFECTIVE POLICY EXPIRATION ....LIMITS LTR POLICY NUMBER POLICY DATEIMMfl)DFM T GENERAL LIABILIITY i GENERAL AGOR-96AT I COMMERCIAL GENERAL LIABILITY I PRODUCTS-COMPIOP AGO 3 CLANG MAOF OcCuFt PERSONAL INJURY III A ADV OWNERS Ill CONTRACTOR'S PROT EACH OCCURRENCE 5 FIRE DAMAGE(Any omfke) 6 MED EXP(Any we p~) 3 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 3 ANY AUTO ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per P--) HIRED AUTOS BODILY INJURY NON-OWNED AUTOS (Per accldent) PROPERTY DAMAGE GARAGE LIABILITY AUTO ONLY.EA ACCIDENT ANY AUTO OTHER THAN AUTO ONLY: EACH ACCIDENT 8 AGGREGATE S EXCESS LUkBIUTY I EACH OCCURRENCE III, UMBRELLA FORM' I AGGREGATE OTHER THAN UMBRELLA FORM A WORKER'S COMPENSATION AND AWC 701199601 04/07107, 04107/08 EMPLOYEFW LIABILITY EL EACH ACCIO%NT I -.-1. THE PROMETOW INCL EL OIS E:POLICY LIMIT S 500.000.. PARTNEABJEXECA)TIVE oPACCR6 ARE I I EXCL IL DISEASE-EA EMPLOYEE 6 100,000 OTHER DESCRIPTION OF OPERATIONSILOCATIONSNP-MCLESISPECIAL ITEMS EII!, Al 0.1.1"? 2 WE 2112 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL TOWN OF BARNSTABLE 10 DAYS"UTTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LOFT, BUT FAILURE TO MAIL SUCH NOTICE SMALL IMPOSE NO OBLIGATION OR LIAORM FAX#: 508' A28-1393 OF ANY KIND UPON,THE. COMPANY, (LT_S, 62FNTS OR REPRESENTATIVES, AUITHIDP#�EPRESKNTATIV* Board of Building Regula ons and Stan ards One Ashburton Place --Room 1301 Boston. Massachusetts 02108 Home Improvemerit-Contractor Registration T Registration: 120362. Type: DBA � �-"--- : Expiration: 1/30/2009 Tr# 261156 PETER FIELD BUILDING & RESTORATION PETER FIELD � �K.�� - ^�--- �M4 P. O. BOX 16 •.; �, r COTUIT, MA 02635 - ---- Update Address and return card.Mark reason for change. - Address Renewal Employment Lost Card DPS-CAI is 5OM-07/07-PC8490 �'k elcl� a/C!o�./�aaocccfucartta — Board of Building Regulations and Standards License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: 1.4 Board of Building Regulations and Standards Registrations_ 120362 One Ashburton Place Rm 1301 Expiration 11/30/2009 Tr# 261156 =i. Boston,Ma.02108 =TYPe DBA. PETER FIELD BUILDING&RESTORATION PETER FIELD ' 857 MAIN ST. ,,,R�..,` COTUIT,MA 02635 Administrator Not valid wit&uwgnifure i BOAOt&rMfii, Construction Supervisor License f License: CS ::65638 . Expiration =7/15/2009 Tr# 16160 ReStflrbon' + ., PETER D FIELD� i. PO BOX 16 COTUIT,MA 02635 y`1 Commissioner a i; Assessor's office (1st floor): R CS�i oFTNEtO Assessor's map and lot number ........�J...... ...IM .......... Board of Health (3rd floor): Sewage Permit number .................................................7'y? Z BARISTLDLE. i NA Engineering Department (3rd floor): o� r`ss: %639 .� a . Housenumber ...................................................:...................... OM a' APPLICATIONS PROCESSED 8:30-9:30 A.M. and 1:00-2:00 P.M. only TOWN. OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO ..........S/.t� '�-/,.Qom.....<� �)/�'J .....A/ ..................................... TYPE OF CONSTRUCTION .............\7.,et).f l.f ................................................ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location .f'�1.5........ .. ..... .............(..,/./. .L ..... . .� �,9 ... L/,.......... ...f�l..l..................... ProposedUse .............,J . ...., ,f................................................................................................................ ZoningDistrict .................�..... ........................................Fire District ..................��.1�?. f.l...........4............................ Name of Owner ........ .................Address ...7d...... ............ i1%Ui 6'/J4L Name of Builder V©/7/U 6 .14142�e' /e.:•••.•••Address .����.....�4`.U,..D D e,P .BA/ C U2 Nameof Architect ............................f ./!J.l...........................Address ....................................... ......... ......................... Number of Rooms ............... ...........................................Foundation �DC� 1P2. G Dive ft'G.f... �.... ........... .......................... .... Exie for .................Roofing �qsll1.... lo /..........................................Interior `$../...Floors .................... ............................................................... Heating ' .`::....................:.......Plumbin !'.Fireplace .. __. .:. ? ?... . . .:.-.-Approximate Cost ( ...( r�.............................. _ram Definitive Plan Approved by Planning Board ________________________________19________ . Area .......................................... Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH Y r rJ-0 ,. OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. r Name ..... ........... ....G.e:;:2,; . ............... Construction Supervisor's License ...............:".................... f P,7-1 DAWSON, DORA A=018-017 No 30303 permit for ......1.'...Story Single Famil Dwellin .....................................'..................... .g............ � Location ........Lots...#46. . ....&....47.1......82....Pine Ridge Rd. .. . .. . .. Cotuit Owner ......D ... ora Dawson. ... .. ...... ................................... Type of Construction ...Frame ................................................................................ Plot ............................ Lot ................................. I Permit Granted December 18 , 19 86 ' Date of Inspection ....................................19 i Date Completed ......................................19 f, AY 7 r /�aX fy;5'1- I TOWN OF BARNSTABLE Permit No. . 0 P3... BUILDING DEPARTMENT "8OAS I TOWN OFFICE BUILDING Cash .: i (�] °�or►r► HYANNIS,MASS.02601 Bond ......X CERTIFICATE OF USE AND OCCUPANCY Issued to Dora Dawson Address Lot # 's '46 & 47, 82 Pine Ridge Road Cotuit, Massachusetts USE GROUP FIRE GRADING OCCUPANCY LOAD THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY-COMPLIANCE WITH TOWN REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. [_��, Ju3Y.. ......, 19.....$......... Building Inspector TOWN OF BARNSTABLE BUILDING DEPARTMENT TOWN OFFICE BUILDING 1039. � HYANNIS, MASS. 02601 'fie cur r• MEMO TO: Town Clerk FROM: Building Department DATE: An Occupancy Permit has been issued for the building authorized by Building Permit $k........._... © ©: ................................................................................................ ...._ .... ...... _ _. issuedto _a D;/./.ri�Cl ............._....................................................................... _........_...................._. Please release the performance bond. I THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINALS) IM A� I -- I DATA a- TbWN OF BARNSTABLE, MASSACHUSETTS BUILDING PERMIT DATE i..�..: ':1 i,r�. 19 APPLICANT ,..�•_,i., ., PERMIT ADDRESS (NO.) .. _... _ -(SSR.EETJ (C0N7 R'S LICENSE) PERMIT TO " (_) STORY ( NUMBER OF (TYPE OF IMPRO)iEMENT) NO. (PROPOSED USE) 'DWELLING UNITS - AT (LOCATION) ' ZONING BETWEEN (N0.)` (STREET) � DISTRICT AND (CROSS STREET) (CROSS STREET) SUBDIVISION LOT BLOCK LOT SIZE_ BUILDING IS TO BE FT. WIDE BY FT, LONG BY - FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION TO TYPE USE GROUP ^ BASEMENT WALLS OR FOUNDATION (TYPE) REMARKS: - - AREA OR VOLUME 0�I'I ESTIMATED COST y�-__ FEE PERMIT µ)_. ,(CUBIC/SQUARE FEET) OWNER ADDRESS , ""�" �- •"" BUILDING DEPT. BY THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET, ALLEY OR SIDEWALK OR ANY PART THEREOF, EITHER TEMPORARILY OR PERMANENTLY. ENCROACHMENTS ON PUBLIC PROPERTY, NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE, MUST BE AP- PROVED BY THE JURISDICTION. STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS. THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. . MINIMUM OF THREE CALL APPROVED PLANS MUST BE RETAINED ON JOB AND THIS WHERE APPLICABLE SEPARATE INSPECTIONS REQUIRED FOR ALL CONSTRUCTION WORK: CARD KEPT POSTED UNTIL FINAL INSPECTION HAS BEEN PERMITS ARE REQUIRED FOR 1. FOUNDATIONS OR FOOTINGS. MADE. WHERE A CERTIFICATE OF OCCUPANCY IS RE- MECHANICAL INSTALLATIONS. D 2. PRIOR TO COVERING STRUCTURAL QUIRED,SUCH BUILDING SHALL NOT BE OCCUPIED UNTIL MI NAL INS RE INSPECTION TO BEFORE FINAL INSPECTION HAS BEEN MADE, 3. FINAL INSPECTION BEFORE OCCUPANCY. POST THIS CARD S® IT IS VISIBLE FROM STREET BUILDI GI PE TIO APPROVALS PLUMBING INSPECTION APPROVALS EL.CTRICAL INS ECTION APPROVALS 2 -- dS 6v S 2 3 HEATING INSPECTION APPROVALS ENGINEERING DEPARTMENT 1 -OTHER -- BOARD OF HEALTH dI -- - WORK SHALL NOT PROCEED UNTIL THE INSPEC- PERMIT W!L L BECOME NULL AND VOID IF CONSTRUCT ION INSPECTIONS INDICATED ON THIS CARD CAN BE TOR HAS APPROVED THE VARIODUS STAGES OF WORK IS NOT STARTED'WI;THIN' SI,', MONTHS OF DATE THE CONSTRUCTION ARRANGED FOR BY TELEPHONE OR WRITTEN PERMIT 15 ISSUED AS NOTED ABOVE. NOTIFICATION. LOW & WELLER, INC. "Fiddler's Green Plaza" 714 Main Street, P.Q Box 119 Yarmouth Port, Massachusetts 02675 362-6868 362-8131 Registered: George Low, Jr., R.L.S. Land Surveyors A. Paul Simard, P.E. Professional Engineers William G. Weller, Consultant December 12, 1986 Joseph Daluz Building Inspector Town of Barnstable Town Hall Hyannis, MA 02601 Dear Mr. Daluz: Enclosed please find revised copies of a Certified Plot Plan which inadvertantly, the building was drawn at the wrong scale, compared to the lot layout. The setback dimensions were and still are correct. Very truly yours, i Willam G. Weller WGW:kew i; f d., �s +' �bTs A& 4 , �� gcxao 1. k Ex IS Idc, O LOT 45 �otJ�lTvA►-(lo� 0 LoT 48 . r;. , a_ 3 AID A47. 1 e g• _ 80.0 _ 1z 1 P6 E AV E £ 4• f fSS' PREPARED FOR �o�� t7At^15vtl CERTIFIED PL 0 T PL AN LOCATION- GoTy,T SCALES � = zG' DATE 11 1 17I$C ` REFERENCE: LOTS 4(p e. 47 P. B. Zep P. 73 _ L.C. P. rr FL 00D ZONE c 4t s• 0 / N.£R£BYCERT/FYTHAT THE BUILDING Q °Eon ''` s; SHOWN ON THIS PLAN /S LOCATED ON THE r GROUND AS SHOWN HEREON AND THAT/T v 8 U7 c,1 dd�s CONFORM TO THE ZONING BY-LAWS OF THE TOWN OF SAVd 5TABLE WHEN CONSTRUCTED. LOW & W£L L£R, INC. r` 7/4 MAIN S TREE T °ic! /�� ' DATE •: YARMOUTH, MASS. ' as,v-Z�8`3 r a�a.. Lo s 4& c`j1 j. 17�+ g" LOT 45 V f5)d14PAT 0 Lot" 48 + x� f � 'R fYl kk ` ,tk 8�O ••� IZ 1 CMG E AV F— PREPARED FOR Rvvo bAW50)J ..... ..... CER TIF/ED PL 0 T PL A N ' r LOCATION• GoTy LT SCALE'S � = Zoe DATE 11 1 17I$<, REFERENCE: LOT-54�, e. 47 P. B. z4, P. 73 . � r L.C. P. FLOOD ZONE G I HEREBY CERTIFY THAT THE BUILDING Q GEOR SHOWN ON THIS PLAN IS LOCATED ON THE s L0' o t 07 r t. u=� GROUND AS SHOWN HEREON AND THAT IT CONFORM TO THE ZONING ° BY-LAWS OF THE TOWN OF 0 �;VlI WHEN CONSTRUCTED. L LOW d WELLER, INC 714 MAINS TREE r b", YARMOUTH, MASS. DA T£ g l SYKES AND COLE ATTORNEYS AT LAW 420 SOUTH STREET POST OFFICE BOX 1358 HYANNIS,MASSACHUSETTS 02601 PETER M.SYHES TELEPHONES: DAVID B.COLE (617) 775-9147 (617)775-2334 MARTHA T.]RAMSEY March 17, 1986 Joseph DaLuz, Building Commissioner Town of Barnstable Hyannis, Massachusetts 02601 Re: Application of Dora Dawson for Building Permit on Lot 17 , Map 18 Cotuit Dear. Mr. DaLuz The petitioner has asked me to write to you with regard to the applicability of M.G.L. chapter 40A section 6 to the above-referenced application. Since the lot in question does not comply with the cur- rent zoning ordinance . area requirement, in order for it to be "grandfathered"under chapter 40A section 6 it must contain 5, 000 square feet of area and 50 feet of frontage. I under- stand that you agree that the Dawson lot complies with the statute. Additionally, the statute states that the. lot must not have been held in common ownership with any adjoining land. I have examined .the titles to Lots 16 , 18 , 22 and 23 and have found no common ownership, other than the original grantor , of these lots as compared to the owners in the chain of title ' of Lot 17. The back title of Lot 17 was traced to Herbert E. Blaisdell who took title from Joseph E. Emerson on November 29 , 1912 . The back title of . Lot 16 was traced to one F. Octavia Ladd who took title on August .4 , 1913 and never conveyed her inter- est in Lot 17 to any owner in the chain of title. The back title of Lot 18 , formerly Lots 48 , 49 and 50 on "Plan of House Lots at Cotuit, Mass . " recorded with the ' Barnstable County Deeds in Plan Book 27 , Page 73 , was traced to Francis Chick (Lot 48) and Samuel H. Whitley (Lots 49 and 50) . Both of these persons took title on August 4 , 1913 , and a y , w Joseph DaLuz, Building Commissioner 2 . March 17 , 1986 neither they nor their successors in interest conveyed such interest to any owner in the chain of title to Lot 17 . The back title of Lot 22 was traced to one Margaret. H. DeWolfe who took title on August 26 , 1913 . Neither Margaret H. DeWolfe nor. he.r successors in interest conveyed such interest to any owner in the chain of title to Lot 17. The back title to Lot 23 was traced to one Clara G. Barrett who took title on August 23 , 1913 . Neither Clara G. Barrett now her successors in interest conveyed out such interest to any owner in the chain of title to Lot 17 . Thus, in .accord with M.G.L: chapter 40A section 6 and the Zoning ByLaws for the .Town of Barnstable article III , chapter III , section G. Non-Conforming Uses (E) , this property may be granted a Building Permit. Please let me know, at your earliest- convenience , if you are in agreement with the above interpretation of the statute and Zoning By-Law as it applies to Lot 17. Very truly yours, MARTHA T. RAMSEY MTR:bgs Q - Assessor's office (1st floor): may. /vv NSTgLL STE AlUs/ oFTNE,o� Assessor's map�and lot number ......... 0,,.�.�J. ......:... � 1 ED 1 M � Board of Health (3rd floor): �,I ,.1 w�HN CDIV1PLlq Sewage Permit number .........::...................................... EN1V1RpNMEN 77TLE 5 / t BaEb9Tl►DLE, Engineering Department (3rd floor): FPS T� TAL C�® N" 9 House number .. APPLICATIONS PROCESSED 8:30 7'9:30 A.M. and' 1:00-2:00 P.M. only ' TOWN. ,OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO ........................ .......(��" ............................... TYPE OF CONSTRUCTION ...........i '........... ........ t!!J� ........1r?�C�/�I. f TO THE INSPECTOR'OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ...... .Q./.. ......... .. .."!`./...............l..f.1.v. ..../.4.11/ ..... •`••! .......... .!...................... Proposed Use �/.lY�F-G.:....... � �! p ................... .. .. Zoning District ................. .. ...�..................................... .� .....Fire Distract �'r.0.l..Ll..t....................................... Name of Owner •Uaeo......... .................Address .. ....../.0/A :!n,.fA4).04.............C.Q.7Ui Name of Builder ..Y..d. /,N..... G /9�.7fQ......Address .�Q�P....SGl �d.eiQ... y....��.�»5........... • Q C G-U Te�PU/c.c- Nameof Architect 1"..© 1i.�0..%........................Address .................................................................................... Number of Rooms ............... ..................................................Foundation p Exterior s� ls?J.v�C' Roofing ...... s .. 1-�G/ .............. Floors • .Interior ................... ............................................................... Heating C`J'/ ® ...1.......Ar i. ...............Plumbing .......... ..... �i .. ................................. Fireplace .....Approximate Cost :GQ:. . ...............:............................ .. ......................................... Definitive Plan Approved by Planning Board _______________________________19________ . Area ` u Diagram of Lot and Building. with Dimensions Fee /... ....� SUBJECT TO APPROVAL OF BOARD OF. HEALTHO „ f� 701L OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ......19./ ............... Construction Supervisor's License .....421V2.? .. rDAWSON, DORA J Flo . 112 Story 30303.3...... Permit for .................................... . ..... (Z Single Family Dwelling ................................................................................ Lots #46 & 47 , Pine Ridge Rd. . v-Locatibn .................................................82............... cotuit . ................................................................................ Dora Dawson Owner ..............................e................................... 'jype of Construction ......Frame.............I.......... * ......................* ....... -plot .............................. Lot ................................ 'Permit G -December 18 ,... 86 Granted .............n..................... 19 ? Date of Inspection ....................................I 1 . Date Completed ........ ...................I..........19 Ut V1 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION 'd I Map r� Parcel I 1 „ Permit# �Q Health Division �4 ` Date Issued -L Conservation Division \ � Fee �l Tax Collector 7x pSEP7 C SYSTEM r,"b e� l'��� Treasure - - INSTALLED III CUMPL9�aNC WiT H TITLE v Planning Dept. 4 ENVIRONMENTAL CODE AND c Date Definitive Plan Approved by Planning Board TOWN.REGULATIONS Historic-OKH Preservation/Hyannis Project Street Address �1�► - `�, `d 9-c' Village Owner37AA Address ?i nc- '?,Ajr k2owio. Telephone Permit Request c�C ti �oow. �G1(�c 3c 0VA _IL Square feet: 1 st floor: existing /dw. proposed 2 floor: existing % '� proposed Total new t' Estimated Project Cost -.2 3 M .00 Zoning District _�11P Flood Plain Groundwater Overlay Construction Type Lot Size rL Gcz 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:. 0 Yes ❑No Basement Type: Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing 12 new Half:existing new Number of Bedrooms: existing a new Total Room Count(not including baths) existing new First Floor Room Count • Heat Type and Fuel: 'Gas O Oil 0 Electric ❑;Other Central Air: ❑Yes - ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes O No Detached garage:0 existing ❑new size Pool:0 existing ❑new size Barn:❑existing O new size Attached garage:existing ❑new size Shed:0`existing 0 new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes,site plan review# Current Use Proposed Use W 3 BUILDER INFORMATION Name P-6 IFr C0 V1 b--WQ C-+ rryr Telephone Number Address License# V-44k vi in c '� p cc S S z roof Home Improvement Contractor# r 17 y Worker's Compensation#-rre 9 c6,,5�,g353 g ri ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO T, ^<1 SIGNATURE DATE _ %"— 9' 1 y 97 C FOR OFFICIAL USE ONLY PERMIT.NO. DATE ISSUED MAP/PARCEL NOS • - . '• _. -" "' f i i -' ' ADDRESS VILLAGE ' OWNER , x DATE OF INSPECTION FOUNDATION LI� _ FRAME t INSULATION ~` •. ° � ._ •. , { FIREPLACE _ ELECTRICAL: ROUGH ' '' FINAL- PLUMBING: ROUGH . _ ' FINAL : GAS: F ROUGH - FINAL FINAL BUILDING DATE CLOSED OUT y: I ASSOCIATION-PLAN NO. -- - Olflce o11A yes M189Oos _ - 600 Washington Street Boston,Mass. 02111 Workers' Compensation Insarance Affidavit name: i 1�oi Wo ocatton C91 C)cc->a v1, ci CD one# n ❑ lam ah0fi=w=pedxming all work myself ❑ I am a sole and Lave no one in anv • � � •on 1 1 employees working on this job... ................... ..;..x.::::::v::.}'i:<•}'•' ::v:::::::...:3:•:t+h]]:•}]}]Yr..}}}vt::}i;i•}}}}:{•:h:^y.:f.•r7v:�ikv^.^.�$<`.}.r-: ...4.::.i:::...... ....... .....:..::.. .r::. ......... . .....:... .. m ... ..:.:...:::.:::.:..:.:::::::::::. ... ............ ... ......n. ........v:.,.........:...•••v:v:w::n.......... .... ........:+x:::::{:...,...;,j,..,rv'v:.::::...vv.}r}��..3Ff`.v.}vi:::.v:�:.-.. ...... ...r.... 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FLOOD ZONE'- "C" ,SP. OWN: REGISTRY OWNER: _WLLIJ_A & KAWRylLy_ TEIL DEED' REFS _600 229 BUYER: sL[2HN-EL& 8f ZE&LL B_R0e 'ERS DATE: r! 96 PLA-N-. PFF--* 2Fi Z SCALF:I..� 24_ FT HEREBY CERTIFY TO. �tP'_ ��_ A K &_ 7�T_.,--_ .�� „r A;,,, - COMPANY___ THAT THE B. `'=�'-"uILDING.: : . ti�. ..Y.ANKEE SURVEY §HOWN �N. THIS..PLAN- IS LOCATED ON. 'CHE-GROUND AS �� I'¢'=� �•. CONSULTANTS SHOWN AND THAT ITS POSITION DOES _ CONFORM r.- ,_- TO THE ZONING LAW SETBACK REQUIREMENTS OF THE 40B (SUITE 1) TOWN OF gA ?YSTWLZ-----_------ -AND THAT F° INDUSTRY ROAD IT' D(7) S t1f(}%'; LIE WITHIN THE SPECIAL FLOOD HAZARD r'� ci r:rt:.. 3(AM'ONS MILLS, MA. 02648 AREA AS SHOWN ON'. THE .H:U.D. MAP DATED,Z//0_,Pf-9 �Ai rLp=` TEL: .428-0055 A150011 0021 D. . FAX: 420-5553 RShiIT EIE VAT o.I L4cT E >rVATI w� j20w1T +-I.EVAT70-J �CQFE�Jf A (3TR[N AJDIYIAN - R� SHARnA) AIAI.CVf-?nN,gSowl SW 778-667Y - ou.wo w�wo v7 - �I o ac« ! �I ��xoaEc�te xe t 'I I D c c cnce171 i ,?� i I /O"SOMA 7VQ Et �'II II van,M Ymb PT POflrj ATVP JPRtq, a-a010 cO�T'tic-y 7f0. T4AME I I Y(.00Q Ptnn/ to�./nwnoa/ F2AMIAc. Pt,4,v d-LO A"$4 F ri JxE c4.0 No lr.��.IATON I:I 1x8 /ram RAKE q- A,AICN FAN✓ AIATCN All T S C/M ONlrf IxYTA�CIA i lxY SGTT/T /A8 iR ISLE 4AY pT. RO lji/l A[l."Eo 7 - l 7S MA"cYsAuy D6cx,AL 3 N/bM 8 v[ TCrAL" TO PD}TS Jxa S�ATy 1 O lilt � 04 .^ Ix6 CEDAR pxo tl�'oC. Cm R�NW Hoo<F AS R cQ a 3.-J 1 �T.6lLr ti" A /b l7Y., =RAM f- SECTp J Sf2ttros 4�G[!1 . T SCALE//u"=/ l 0 . The Town of Barnstable � • •asarrsrw�. II Department of Health Safety and Environmental Services Building Division 367 Main Street,Hyannis MA 02601 Office: 508-862-4038 Ralph Crossen Fax: 508-790-6230 Building Commissioner Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. Type of Work: 2 cc�e"" 9,; a cA c,— Estimated Cost 0.0 a Address of Work: 1 Ny Owner's Name: Syh " `C oAC-15 Date of Application: _ q— l 5 9 I hereby certify that: ' Registration is not required for the following reason(s): Work excluded by law C]Job Under$1,000 Building not owner-occupied r]Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A. SIGNED UNDER PENALTIES OF PERJURY f I hereby apply for a permit as the agent of the owner._ ?- 9-i f 9 9 !n o4 Date Contractor Name Registration No. OR Date Owner's Name q:fomu:Affidav 9qe eommvweveala HOME IMPROVEMENT CONTRACTORS REGISTRATION oard of Building Regulations and Standards One Ashburton Place - Room 1301 : Boston , Massachusetts 02108 4t HOME IMPROVEMENT CONTRACTOR Registration 128174 Expiration 03/04/01 Type - DBA MICHAEL C . ROLFE MICHAEL C . ' ROLFE 296 OCEAN ST/PO BOX 864 HYANNIS MA 02601 ��te -r�oryn.�na�uueal� a`�.l��z;aar�u�el(.i OEPARTNENI OF pUBLIC SAFETY CONSTQKL ON SUPERVISOR LICENSE Na�ber Expires: . _ Restncted,�To 00 'yy ' .a►� �:. NICNAEL C ROLFE =PO BOX 864 - ' NY�NNIS, MA 0260� r .. 0 (A. U) 60 r co t A GONT. RIDGE VENT �) uDi r 2X8 RID6E 0 .' v U) +� GONT. 2X8 ARCH,12 A5PHALT 5HINGLE5 O.G. i 2X8'S� 16" � W (2) 2X8 HEADER s+ W.G. 5HINGLE5 (T,M.E) I/2" GYP.BD /2" GDX PLYW00D IX3 5TRAPPING 2X4'S _ .._ R-13 F.G. IN5UL. 2X4'5 ®..16' O.G., EXISTING'.BEDROOM R 30 F;G. INSUL-. Il2 GYP. BD. GU5TOM WINDOW MM 3 5EAT _ U ¢ _ Na 2ND FLOOR 0 NEW ARCH. 3'-6e A5PHALT 5HINGLE5 3 1/2' 3 I/2" EXI5TIN6 KITCHEN EXI57IN6 LIVING ROOM :P A RTI A L PAfig' TIAL 1$b 4 5 E G T I O N E L E V A T 1 O NyEel � � °" 5 G A L E`. 1 / 4 " = 1 ' — D 5 G A L E I. / 4 = I ' — O " ° bti° a; EXI57IN6 BASEMENT r" J.0 eo.: oboe a-te JAN.14,2002, A9 NOTED _ - dream OPERATOR, _ 5 G ALE ^ 4. ki