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HomeMy WebLinkAbout0062 POINT ISABELLA ROAD r ,I 1 X i " 1 rK.M4 s Y wk+t+w+h _,s.. ; 0 I Barnstable Town of'Barnstable Department of Public Works AD-Am mericaC9ty BAMMB1639. ,0� 382 Falmouth Road H A 026.01 r a , anrusM Y http://www.town.ba,mstable.ma,us 2007 Daniel Santos,"Director Office: 508-790-6400 Fax:: 508-790-6406 Saner M.Bhatt 19 Shelley Road Wellesley,MA. 02,481', Date:,August 5,-2013 Re:.Address reassignment for Map 074 Parcel 025,#20 Leeward Way,Cotuit. Dear:Mr..$hatt, This notice is the follow-up to your email request to assist with the address identification Of your property identified above-. As I mentioned ki myresponse;many records.needed. to be reviewed to identify the problenm(s)locating your property in your neighborhood,. and to develop the changes)that would be-required to better identify.your'property;. especially in the-event of an emergency. Review of the records of he area indicates Leeward Way is defined as a road-shown;on a plan recorded as;Land Court Case.3216 E(copy encl.). This road was approved bythe Town of Barnstable's Planning Board on July'21, 1080. This road was approved at a substandard width of 20 feet. Contact with the Highway Department.reveals there is no indication that they have provided any maintenance to Leeward Way; The Town of Barnstable's GIS`maps;do not.have Leeward Way labeled with'its road name.Both. abutters, other than you,are addressed and taking access off Point;Isabella.Road. Leeward.Way."appears"to be a driveway and not a road as?roads are ty "calI tdp.1n tified in the.Town of Barnstable. Because of the currerit,conditi'ons of Leeward Way.I agree that'a new address:assigned for Point.Isabella Road would better identify your property. Therefore,.the new address assigned for your property identified above is#62 Point'hsabella Road,Cotuit, This number must be posted at the entrance of your driveway/road on Point Isabella Road as identified in the.enclosed Town of Barnstable's Ordinance.for Numbering of Buildings.It most also be posted on the building to be visible from thedriveway. Please'be aware that this address reassignment is for your property identification only and does not-,eliminate the legal description of Leeward Way'.If the conditions in this area change relative:to.the i'deritification of Leeward Way; your address may be changed back to the original address of Leeward Way. Changes in conditions could involve,but are not limited to,-one of the abutters relocating their access,to Leeward Way with a ,request for a. Leeward Way address: Re-assigning the address of your-property to Point Isabella Road does not abandon or discontinue this road. The address re-assignment just provides better identification of your property'In your neighborhood. Any expanded use of Leeward Way could proinote its identification in the field and may-require this office to change your address back to Leeward Ways:I have included a copy of the Town of Barnsta'Me';s Common Address questions that identifies the issue if your;address can,be.changed again, Since Leeward way is,a private subdivision road,.the Town of Barnstable has very little regulatory control over'the usage of this-road Please contact me if you:require further° assistance with this matter. "Since e1' , Frank Schleel E911 Data Liaison Engineering Records Manager DPW/Technical Services 382 Falmouth Rd./Rte 28 Hyannis,MA. 02601 PH: (508)790.-6400 x-4942 FAX: (508)700-6406 fr.ank.schlegpl@tow.n.barnstable-.ma,,us s E f F �tFff T o� Town of Barnstable BMtNSTAULE,r Department of Public Works i63 382 Falmouth Road H EO MA'S p �, annis MA 02601 Y http://ww.w.tpwn.bamstable. a,us. Office..508-790-640.0 DanielS.antos.,Director Fax: .50'8-790-6406 Roger Narso➢s,PE."Town.Ewg eer . i f SUBJECT: Numbering of Buildings Map No.Q 7 Parcel No O a.5- R Date= fqu&(,Sr S, aQ L3 E Dear Property Owner; E Notice is hereby given in Accordance with the General.Ordinances of the.Town of Barnstable, Chapter 11I,Article:V;Numbering of Buildings,.adopted March.3.,1931,revised July21,1994 public convenience and necessity requires the..assignment of number 6 a for your property located on po/wr Y'YA6E1-1-4 Ra-W 007yi r- STREET NAME VILLAGE This number should be affixed to your building"so that it is visible from"the.street as outlined in Exhibit"E", Town of Barnstable.Rules and Regulations for'Numbering of Buildings. Please contact Mr. Frank Schlegel.at the Engineering Division at(568) 790=6400 x•4942 and be prepared to provide all telephone numbers at this location So that your E-941,account records can be confirmed when the correct building number,is posted:: Roger Parsons;PI; Town.Engineer encl. ' T.O.B..Rules&Regs. a/Com-mon Questions _✓S`ite Map _ Assessors Change'Forin THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINAL (S) I A CL I m / �(JL DATA Z9)040 LIJN/C/I'WAS rr Nos'`) i :N 4 -7 8' 0 "5z' \V / ' , \ r. \I � /�C P�o�FLT lvlk�ti�e- /DEGIC \\\ `� � Iv =%R' �. RUCs"���< \ �-\ � • It v< - 11.0 { LG7CATIO�J S F �,� " P RCS E'p ,QI PLAT G�Ai J LOT -7-A GdM1J IT lOD U G�L, I c� � �! 17 7 �Ae, S HORES F7A L1d3TA P�1-E s S ?Ti ( I V i \ a r /y�,gSS. DhTE f� o(o•'S 1 00 {2. 7ia.+//� 4 N 1� ^C ( ✓J O'NC-Ar2+J. -C"C- ,Ertl-.T DENi.JISi 7 'L ` /0O �- ! - -- --- 7 Z A5 r3ut�r ; EGt-V. { >',A n/K /Sal n . �l 0L.7lE7 Sf!�1/G TitN/t fSc 4 �' OS.F /S•2S /,/L�T r':�T 7k /sp2 %6 u.�c. <LOT 5�7 15 0'F2ourA 6 4 r L�AGl�.T�CL.NIH moo ' F. S. 6. H �h OL V�> . D P P457Ec►l o&J u u QED 1�`' f .�s,!±i R36 •b2A-0 FATF-1 EP- ... v'.. ..::. of � � CERTIFIED PLOT PLAN ROBERT � c / BRUCE` '" ��/a(h' Cr� ®�► c7 ?"f� C' / 7- IN �erAit_ ADDcD I!19lik- .8 sj _:�s't '1.;�.�..1 ,j' '���11.•... � -7 .� �. � -..\,_.- �ti' .rt Pr' .f "�xiir v,<, nyrli,cnr it zrD<!f v }( j �ro V Ar .? Y. }��! ;-', �, i ,. .y ;.,,ti�fi '•' ° .�CALE�:a lx. �Q D:.;:D,A1'Es ek?.....Fi{ °kn•Y `'Y ^' d+>.. u .'rs'4 f ��s ri :a+w i _ ''•. .� r:, - - •.r t Y s �>5; Rny ^ ' v� ry ,��yM f?•••tj rr''•�'�. �...i� +' $:'!�'7"Y} E0I3TE ?I:D HEGIgTE ED SHoivN 0H THIS PLAN IS LOCATED J®m No 8�`�Z3 ON THE GROUND AS INDICATED AND CIVIL LAND CONFORMS TO THE ZOFdiPJf3 L,41�5 EPdC�IE E�; U MORN. D�.D°f: sLF.A '�'1� OF UARNSTABL , MASS. Ezc3E:PrP,-5"afeD � I2 MIDI N STREET * . . �C:9,r;yr ' G' klASS .-KEE /,O �^ alb is R=6. LAND SURVEYOR � ➢tY.:-�L�muerum®,-.�.TaCLSm-3a'31^'eN::•'•�:�•�•-- ^• � e.]mSAsaaeaan+sa '1'.m.w•or..r.-r ,..e.".- -- L. P ® r i � � �>lie -�o,miy►�mtuetz�� o����ac,�uule� ry w HOME IMPROVEMENT CONTRACTORS REGISTRATION ° Board of Building Regulations and Standards One Ashburton, Place - Room 1301 '`4:•: Boston , Massachusetts 02108 HOME IMPROVEMENT CONTRACTOR ---------------------=---- Registration 110609 Expiration 11/03/94 Type INDIVIDUAL. CTT on y�✓ u, HOME IMPROVEMENT CONTRACTOR Em Registration 110609 E .J JAXTIMER Type - INDIVIDUAL ERNEST J . JAXTIMER Expiration 11/03/94 48 ROSARY LANE HYANNIS MA 02601 E J JAXTIMER ERNEST J. JAXTIMER I 48 ROSARY LANE A s ADMINISTRATOR HYANNIS MA 02601 o o 7' COMMONWEALTH DEPARTMENT OF PUBLIC SAFETY .� FailarstoPessassacurrent- wr l _-OF ONE ASHBORTON PLACE dNassachuss¢tx stateaultding "=MAtSACHUSL-TS -':= ;< .BOSTON;MA 021n8�"-�---- _._ ,.G.Qd4iscaaso torrerOcgtlOa _ ofPhis►ICasse. . EXPIRATION DATE 1,0677 CONSTR` SUPERVISOR CAUTION j --01/14/199 6 EFFECTIVE DATE LIC-NO. FOR PROTECTION AGAINST RESTRICTIONS NONE - THEFT, PUT RIGHT THUMB I . .. „ T 06/30/1993 003251 PRINT IN APPROPRIATE r o - : o' p,ERNEST =J JAXTTKER s BOX ON LICENSE. ROSARY LANE` ' SS,,�, 012-46 ,4256 `. ^ Z HYANNIS MA=Z2b01 B!,4STINGOPERATORS m Z :,MUST INCLUDE PHOTO. PHOTO(BLASTING OPRONLY) F 0� NOT VALID UNTIL SIGNED BY LI EE AND OFFICIALLY - P- I HEIGHT: STAMPED-OR.-SIGNATUR- THECOMMISSIONER I ilDOB: /14/1956 P9 3 THIS DOCUMENT MUST BE « SIGN NAME IN F SIG CARRIEDONTHE PERSONOF SIG NATURE LINE NATU OF LICENSEE i. THE HOLDER WHEN EN- -•oO OTHERS RIGHT THUMB PRINT GAGEDIN THIS QCCUPATION ! a . . t M .T.1'.t+'^':.. .:; rl a^ .••'S+dt4 "gar-.�«r:•r.:✓.5'�x_ ..,,� rt . s Aasessiir's'office(1st or): 6 r�f1 `Assessors map an num 7 `TME T Conservation 0NV 3®00-IVIN3N!Board of Health d floor): .w � ���� 3-1ill H I� 1: Dea'7T►nLt Sewage Permit mbar �l R � A Grua Engineering Department(3rd floor): &AV ' 3�m�V11dW03 V1 C''6 . o.9�ai.o. House number r-,,.- - oast Definitive Plan Approved by Planning Board 19 APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2-00 P.M.only TOWN OF BARNSTABLE BUILDING INSPECTOR yV APPLICATION FOR PERMIT TO Bathroom Remodel / Sunroom TYPE OF CONSTRUCTION Wood / Residential August 30 , 94 19 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location 20 Leeward Way, Cotuit , MA Proposed Use Residential Zoning District R F Fire District C o t u i t Name of Owner Mr- & Mrs. William Crawford Address 20 Leeward Way, Cotuit , MA NameofBuilder E.J . Jaxtimer Address 48 Rosary Lane , Hyannis , MA Name of Architect Northside Design Address 141 Main Street , Yarmouthport , MA Number of Rooms 2 Foundation Poured Concrete/Block Exterior Wood Shingle Roofing Asphalt Floors Wood/Carpet Plaster Interior Heating FHA Plumbing Remodeling Bathroom Fireplace None Approximate Cost $ 35 ,000 .00 Area �300 sq. f t . Diagram of Lot and Building with Dimensions Fee OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regardi a above construction. Name Construction Supervisor's License 003251 CRAWFORD, WILLIAM .No 37004 Permit For ADDITION Single Family Dwelling Location 20 Leeward Way Cotuit Owner Mr. & Mrs. William Crawford Type of Construction Frame r Plot, Lot R Permit Grante September 2 , 19 94 Date of pection���� Date Completed 19 El!A s.,,�• :fl.. r .a .. , .y _ T.. _ 4=`` ly-,,"^ •`.•.ty j„ � we •d .,..a .r=.F. .:,_a .r - - Pas.. 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BYRNE y yyep�'o° T�ISET) �• / .. yEXISTING 8 LOIN �'G tJ� �a i°�y. ,t NP o• ��•� • r ��4•eb a �[ R°Z7.97 F=25.00 A� ti � 3.64 �,,•.g. o� e' R+273.42 •s0�'dR• 1.08.99C . 5 yr� 46.p3 40 2,oT `% 40'WIDE 1 �`�yr R-2300 & 5 T��O r PRIVATE Roq!� Q' Mrf: Car y �� U b`'' CNIe'wid0 /3Y�.C. SS ola `N� %i LOT Q o oar 1. _ihar.,Clerk of the Town of Barnstable,hereby certify NOTE I thatthe notice of approval of this Plan b/the - BEING A RESUBDIVISION OF LOT 6 8 LOT 7 ON Planning Board has been received End re- THE PLANET ON LOT T-AINAIVED FRONTAGE corded of.this office=4 no mfice clapped TO ZO FEET ON LOT 7Z IN ABCORDAyCE WITH LAND COURT PLAN N0: 3216•C was received during the twenty days next SECTION J.E OF THE ZONING BY-LAWS. OWNER 6 SUBDIVIDER + offer Such receipt and recording of sold notice. " COTUIT BAY SHORES REALTY TRUST <• f 28 STATE STREET _ L' `"�'°"' ,MASSACHUSETTS /+;>ti.Town clerk BOSTON APPROVAL UNDER THE SUBDIVISION CON�ROL LAW 15 REOUIRED. ZONING DISTRICT BARNST ABLE PLANNING BOARD RESIDENCE F 9 am� Land Court Plan of Land W uerr in °r s 4� � COTUIT , BARNSTABLE GATE APPROVED, =,- 1984' /� � MASSACHUSETTS DATE SIGNED: Aky.10- 1980 1✓w�',u. _ ,. Prepared For 7 COTUIT-BAY:SHORES REALTY TRUST I CERTIFY THAT THIS ACTUAL SURVEY WAS MADE ON THE GROUND IN ACCA DANCE WITH - II i THE LAND COURT fNSTRUCTIONS OF 1971 BETWEEN JAN.2G,19T3 AND MAR.21 1973,BETWEEN SCOIQ :'1 -= 40 June 12, 1980 NOV.22.1974 AND DEC.27,1974,AND MAY 12 1980 AMC THAT THE CONOITIANS ARE THE SAME NOW ON THE GROUND AS AT THEJIME a THE ORIGINAL SURVEY. BOHANNONs LAND SURVEY CO. �2— /: /980 WArlt- it o3pia.'_ J — 99 PLEASANT ST. DATE REGISTERED LAND SURVEYOR WEST'BRIDGEWATER, MASS S , N 14 -7 bf /4 0...0 J� Lo r -7 - / Q, \ \ / Q 13.0 ' lz t�QlE : 13acC+K V-D6E WE'TLA-Jb o o ti ! 1-s o \ 4 l LdCprTlO►.•1'3 FROM "P RG7LY7'+�'O �. � \ � O SOT .-1-A G'477tiJ IT MA'JS., DATED 0�-lb , 00 , R•,J• L1iG., EAST pEn�utS, MASS." 3 Q' 9 7 2-0, o�__ _ _� .. s 9 ° s2 33 vV °o Q 3 7 15 O F�'o E P-5' -'�A�c..Utrt�G P���-n o�I u._►DE2- !\ OF y >°� lrRT►cl lzL,cNA Pj-!Lf?-UE. Cm;F, v 3 g • CERTIFIED PLOT PLAN 0 -7"S IN SAJIBS'fA,9LA4ldASS. SCALE: / "= -? ,) ' DATE : 4 LDREDGE ENGINEERING COIN Ti5L4 E 6E/I/ I CERTIFY THAT THE FcuJWCI IIOo .1 CLIENT SHOWN ON THIS PLAN IS LOCATED EQISTERED REGISTERED J08 N0. 8Z= ON THE-GROUND AS INDICATED AND CIVIL I LAND CONFORMS' TO THE ZONING LAWS ENGINEER , SURVEYOR DR.BYj �•� OF' BARNSTABL , M SS.EyaEPr 4,5 j aMD 712 M A I N ,i T R E E.T CH.BYE `� 04 15'1 V , '• _._ HYANNIS, AMASS. SHEET<OF DATE REO. LAND SURVEYOR i i 4_ i r AW t u I®I l , t r r , e v pp 'y f , } is i� d , x t J t i NLL t � k t f• tV ley , r " 1 a ( , 11 5;` l_. y If:.kyj._.I _ •',r o- - _ `_ �-.--,--"'31�� -?F __,-s�---r.,p a�' s,.: - ._ t TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Ma Parcel A lication � p PP Health Division Date Issued ZsJ1 K Conservation Division ✓ Application Fee Jv Planning Dept. Permit Fee (40- Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address Villager Owner r Address Telephone 9`�� - �S� -C:G>A�cT Permit Request , ^ cal c�eC F��rr: e 2� guar � oo g proposed Total new `� Zoning District Flood Plain Grou water Overlay t Project Valuation , o-0-• Construction Type 0-6T fAtV- O Ic P6Zw� �AU� PV Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting document ion. 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 a Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑ existing ,D ne Qsize_ `'Attached garage: ❑existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ �' v a� Commercial ❑Yes ❑ No If yes, site plan review# -'•_ Current Use Proposed Use w APPLICANT INFORMATION --- - - (BUILDER OR HOMEOWNER) O�95- Name Telephone Number �- Address c2 License # 0-7 Z570 /30531 Home Improvement Contractor# Email Worker's Compensation # .9 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO ' SIGNATURE DATE Z � 1 . FOR OFFICIAL USE ONLY •� ` APPLICATION# s DATE ISSUED MAP/PARCEL NO. z ADDRESS VILLAGE OWNER DATE OF INSPECTION: N FOUNDATION FRAME INSULATION FIREPLACE s ELECTRICAL: ROUGH FINAL f PLUMBING: ROUGH FINAL i GAS: ROUGH FINAL FINAL BUILDING I� I DATE CLOSED OUT i i ASSOCIATION PLAN NO. f iJ r The Commonwealth of Massachuseft Department of Industrial Accidents Office of Investigations ' 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit:Builders/Contractors/Eleetricians/Plumbers Applicant Information Please Print Legibly ,Name(Business/Orgmizagonuciividual): J _ r Address: � � a City/State/Zip:& Phone M p . Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I employer with 4. I am a general contractor and I ployees(full and/or part-time). * have hired the sub-contractors 6 ❑New construction 2. I am a sole proprietor or partner- These sub-contractors have listed on the attached sheet 7. ❑Remodeling ship and have no employees 8. []Demolition working for me in any capacity. employees and have workers' [No workers'comp,insurance comp.insurance,# 9. ❑Building addition iequired-] 5. We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself [No workers'comp. right of exemption per MGL 12.0 Roof repairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' 13.0 Outer comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. lContiacto:s that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment;as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties ofpedury that the information provided above is true and correct. Si mature: Date:`—- � _/ Phon Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/Lkense# 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#: r.._• fc -Information and Instructions y n . Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuantto this statute,an employee is defined as"...every person in the service of another under any contact 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 construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance,coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance. requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s), address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships (LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and-date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permi icense number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street BQston,MA 02111 Tel.#617-727-4900 ext 406 or 1-877-MASSAFE Fax#617-727-7749 Revised 4-24-07 • WwW.mass.govfdia oT Town of Barnstable Regulatory Services WASS �* Thomas F.Geiler,Director 16.1 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, !Sr' '�''''� r� ,as Owner of the subject property hereby authorize G%- to act on ray behalf, in all matters relative to work authorized by this building permit. i (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 ate performed and accepted. Signature of owner e of Applicant Pant Name Print Name Date Q:F0RMS:0VR4 RPERMISSI0NPoDL-s 6012 Town of Barnstable _ Regulatory Services Thomas F.Geiler,Director 16 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 HOMEOWNER LICENSE EX ITON Please Print DATE: JOB LOCATION: number sheet village -HOMEOWNER- home phone# work phone# name CURRENT MAIIING ADDRESS: cityltown state zip code The current exemption for"homeowners"was extended to in owner-occupied dwelIin>'s of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Persons)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 buildings Uermit. (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 1 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. HOMEOFVIMVSEXEMPTION 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 109.11-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. -this ease,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. art of the To ensure that the homeowner is fully that of his/her responsibilities,many corn munities require,as p permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. C:\Users\demUWAppData\Local\Microsoft\Wmdows\Temporary Internet Flies\Content outlook\QRE6ZUBN\EXPRESS.doc Revised 053012 Office of Consumer Affairs&BusmessJaa�aQeCt�- c�lheoai�mearuuea z o� License or registration valid_for individul use only Regulation before the expiration date.-If found return to: 'RME IMPROVEMENT CONTRACTOR Type Office of Consumer Affairs and Business Regulation egistration 129922 10 Park Plaza-Suite 5170 piration 11/23/2015. DBA Boston,MA 02116 JEFFREY CLANCY CONTRACTING JEFFREY CLANCY` � 2 CARLETON DR. E.SANDWICH,MA 02537 """ Undersecretary Ava► ithout signature Massachusetts -Department of Public Safety Board of Building Regulations and Standards " Construction Supen isor 1 & 2 Fam_ill License: CSFA-072570 r IS JEFFREY E CLANtY - '• 2 CARLETON DID �a '4 E SANDWICH Na 02537 JJ/Sl " Expiration Commissioner 09/21/2014 5b� • ��- oc�ca�l �---- Ay ,--; i 25 �t w LA E f5 N � - e� 1� �. r OV y -IDcl -,z Av- ss C k � 4 e � __ _ _ :�-:•�- s--- ,.•a! �� -m ..mow.,.....,..- «.-• -^+�°---*�. --—•�. +.�,.. ...._.. 7 , ,u '�, t Boa r c ^� A TI Evaluation Service A Division of Architectural Testing — Certification Services Code Compliance Research Report CCRR-0114 Subject to Renewal: 11/23/2014 Issued: 09/03/2013 Visit www.ati-es.com for current status Page 1 of 13 TimberTech Limited 3.2. The RadianceRaiP composite guardrail 894 Prairie Avenue system includes top and bottom rails, two Wilmington, Ohio 45177 support rails, infill, post sleeves, rail-to-post (866)862-7832 brackets, support blocks, foot blocks, and www.timbertech.com decorative moldings. 3.2.1. RadianceRaiP rails (top, bottom, and support) and post sleeves are manufactured 1.0 Subject from extruded shapes in seven colors; Coastal Guardrail Systems White, Mountain Cedar, Classic Black, SandRidge, RiverRock, Traditional Walnut, and RadianceRaiP Composite Guardrail System Antique White. All components are co-extruded RadianceRaiP Express Guardrail System with a PVC color cap layer and wood/plastic composite core. 2.0 Research Scope 3.2.1.1. RadianceRailo, infill options are 2.1. Buildinq Codes: described in Table 2. 2012 International Building Code(IBC) 3.2.2. The top rail assembly consists of two 2012 International Residential Code(IRC) rails, an upper rail assembled over a support rail. The two rails are held together with a series 2.2. Properties: of coated screws. See Figure 1. Structural Performance 3.2.3. The bottom rail consists of two rails, a Durability bottom cap rail assembled over a support rail. , Surface Burning 3.3. The RadianceRaiP Express guardrail system includes top and bottom rails, vertical Decay Resistance balusters, post sleeves, rail-to-post brackets, foot blocks and decorative moldings. All Termite Resistance components are produced in Classic Black, 3.0 Description Coastal White, and Traditional Walnut. 3.1. General — The TimberTech° guardrails 3.3.1. RadianceRaiP Express rails (top and are offered in two assemblies, RadianceRaiP bottom) and post sleeves are co-extruded with a and RadianceRaiP Express, and are guardrails PVC color cap layer and wood/plastic composite (guards) under the definitions of the referenced core. See Figure 2 and Figure 8. codes. Guards are intended for exterior use at or 3.3.2. Balusters are hollow, co-extruded PVC . near the open sides of elevated walking areas of 4' p 9 material. See Figure 4. buildings and walkways as required by the referenced codes. 4.0 Performance Characteristics 3.1.1. Level guards with heights of 36 inches 4.1. The TimberTech° guardrail systems or 42 inches above the floor surface are described in this report have demonstrated the provided in rail lengths up to 91.75 inches. This capacity to resist the design loadings specified provides a maximum 8 feet (96 inches) from in Chapter 16 of the IBC and Section R301 of post center to post center. See Table 1 for IRC when tested in accordance with ICC-ES qualified lengths and configurations. ` AC174. 3.1.2. Stair guards are provided in rail lengths 4.2. Structural performance has been up to 91" inches as measured along'the upper demonstrated for a temperature range, from rail. See Table 1 for qualified lengths and -20OF to 125°F. configurations: Architectural Testing 130 Derry Court• York, PA 17406 717-764-7700 www.archtest.com TOWN F "R STABL 78 M 7 if rt z :. DI1SI . �A TI-ES Code Compliance Research Report CCRR-0114 Page 2 of 13 4.3. Materials used are deemed equivalent to 6.3. The reports of testing and engineering preservative treated or naturally durable wood analysis demonstrating compliance with the for resistance to weathering effects, decay, and performance requirements ASTM D 7032-08, attack from termites. Standard Specification for Establishing 4.4. The composite core material with PVC Performance Ratings for Wood-Plastic capstock and the components with PVC material Composite Deck Boards and Guardrail Systems have flame spread index values of 75 and 30 (Guards or Handrails). respectively when tested according to 6.4.A quality control manual that is in ASTM E 84. The referenced criteria within accordance with the ICC-ES AC10, Acceptance AC174, requires a flame spread index not Criteria for Quality Documentation, approved exceeding 200 when tested in accordance with December 2012. ASTM E 84. 7.0 Conditions of Use 5.0lnstallation The guard assemblies identified in this report Installation shall be in accordance with the are deemed to comply with the intent of the manufacturer's installation instructions and this provisions of the referenced building codes report. Where differences occur between this subject to the following conditions. report and the manufacturer's installation 7.1. Guards are installed in accordance with instructions, this report shall govern. See Tables manufacturer's published installation instructions 2 and 3 for installation details. and this report. Where the manufacturer's 5.1. Foot blocks are a section of nominal 1.2" instructions differ from this report this report square extruded composite picket with a solid shall govern. composite insert or expanded PVC core to 7.2.Guardrail systems recognized in this report facilitate fastening. Foot blocks shall be installed and regulated by the IBC or IRC are limited to at approximate 1/3 intervals for rails over six feet exterior use in all construction types where wood in length or at mid-span for rails less than six _ is permitted in accordance with Section 1406.3 feet in length of the bottom guardrail between of the IBC and in One and Two Family Dwellings the deck surface and the guard rail. See Table 3 and Figures 8 through 11. regulated by the IRC. 52. Guardrail systems may be attached to 7.3. Conventional wood supports for guards are conventional 4x4 wood posts or other suitable not within the scope of this report and are wood support structure. The wood in the subject to evaluation and approval by the supporting structure shall have a specific gravity building official. Supports must satisfy the design of 0.50 or greater (Southern Yellow Pine or load requirements specified in Chapter 16 of the better) and a minimum thickness to allow full IBC and must provide suitable material for penetration of the bracket mounting screws. anchorage of the rail brackets. Where required Conventional 44 wood posts or other wood by the building official, engineering calculations supports are outside the scope of this report. and details shall be provided. 6.0 Supporting Evidence 7.4. Compatibility of fasteners and other metallic components with the supporting 6.1. Drawings and installation instructions structure, including chemically treated wood, is submitted by the manufacturer. not within the scope of this report. 6.2. Reports of testing and engineering analysis 7.5. Compatibility of the supporting construction demonstrating compliance with the performance materials with all fasteners, metal post mount requirements of ICC-ES AC174, Acceptance components, and other hardware components is Criteria for Deck Board Span ratings and subject to approval by the building code official. Guardrail Systems (Guards—and Handrails), approved January 2012. 7.6. Only, those types of fasteners and fastening methods described in this report have been evaluated for the installation of TimberTech° guardrail systems; other methods of attachment are outside the scope of this report. Architectural Testing 130 Derry Court• York, PA 17406 717-764-7700 www.archtest.com TOWN OF BARMITABLE 2014 AIIIR 22 AM 8 eel �A TPES Code Compliance Research Report CCRR-0114 Page 3 of 13 7.7. Where required by the building official, 8.2. The applicable guardrail assembly engineering calculations and details shall be performance levels as stipulated in Table 1 of provided. The calculations shall verify that the CCRR-0114. anchorage complies with the building codes for 8.3. The designation"ASTM D 7032" the type and condition of the supporting construction. 8.4. The phrase "For Use in One- and Two- 7.8. The ®guard systems produced by Family Dwellings Only"when applicable. TimberTech identified in this report have not 8.5. The Architectural Testing Code been evaluated for use in areas subject to Compliance Research Report mark and number Formosan termite attack. (CCRR-0114). 7.9. TimberTech° guardrail systems, with the 9.0 Code Compliance Research Report Use exception of the balusters, are manufactured by TimberTech Limited in Columbus, Ohio. The 9.1. Approval of building products and/or balusters are manufactured by Crane Plastics materials can only be granted by a building Manufacturing in Columbus, Ohio in accordance official having legal authority in the specific jurisdiction where approval is sought. with the manufacturer's approved quality control system with inspections by Architectural Testing 9.2. Code Compliance Research Reports shall (IAS AA-676.) not be used in any manner that implies an 8.0Identification endorsement of the product by Architectural Testing, Inc. The guard systems produced by TimberTech® identified in this report shall be identified with 9.3. Reference to the Architectural Testing labeling on the individual components or the internet web site address at www.ati-es.com is packaging and include the following; recommended to ascertain the current version and status of this report. 8.1. Name and/or trademark of the manufacturer. Table 1 -Railing System Building Code Recognition TimberTech®Guard Guard System Size(Length x Height) Systems Type of System y IBC(3) IRC(4) Level/In-Line Application RadianceRaiP 91"x 42" 91"x(36"or 42") Level and Stair Level/45°Application�'� Stair Systems(Z� 91"x 42" 91"x(36"or 42") Level/In-Line Application 91.75"x 42" 91.75"x(36"or 42") RadianceRaile Express Level and Stair Level/450 Application�'� 90"x 42" 90"x(36"or 42") Stair Systems c2) 86.375"x 42" 86.375"x(36"or:42:-) Level Railing lengths are maximum clear length between supports. Railing height is the minimum installed height from walking surface to top of top rail. (2) Stair Railing lengths are maximum clear length between supports. Stair Heights are measured vertically from the leading edge of the stair nose. (3) All Use Groups (4) Limited to use in One-and Two-Family Dwellings. Architectural Testing 130 Derry Court• York, PA 17406 717-764-7700 www.archtest.com TOWN OF 9ARNSTABLE 20111 APR, 22 Alm �: 2 �A TI-ES Code Compliance Research Report CCRR-0114 Page 4 of 13 Table 2 -Rail and Baluster Descriptions -Guardrail System Rail Description Infill Options Infill Fastening Description A solid PVC composite baluster with an expanded core with a drilled pilot hole at its center to provide a means for Nominal 1.25" square locating a fastener. Expanded cellular PVC core. Balusters are held-in-place with coated screws inserted See Figure 3. through pre-drilled holes in the upper support and lower rail sections. For all balusters, one#8 x 3" long coated screw is utilized in the top and one#8 x 2" long coated screw is used through the lower rail. Top Rail Assembly: The upper and support rails Stainless steel cables are attached to each post sleeve (Figure 1) are fastened with a with Quick-Connect®fittings (swivel'fittings for stair). Cables series of four equally spaced#8 are installed at 3" on center and 3-1/16"on center for level x 2" long coated screws that and stair rails, respectively. RadianceRail® pass through pre-drilled holes in the baluster side support rail and VFeeney®-Cab/eRail wiwith Intermediate, 3/4 inch square, 0.062 inch wall thickness, threaded into the topsail. Quick-Connect®fittings-and 6063-T6 aluminum balusters are spaced no greater than 30 Bottom Rail Assembly: 3/4 inch sq. aluminum inches on center along the length of the rail. Balusters are The bottom rail includes two intermediate balusters. secured to the bottom rail with one#10-12 x 2" pan-head independent rails: a support rail stainless steel screw and the top rail utilizing an and a bottom cap rail. Figure 1. intermediate base plate (attaches to the baluster with one #10-12 x 1"flat-head stainless steel screw and attaches to the top rail with two#10-12 x 1"flat-head stainless steel screws. See Figure 10. Steel balusters are attached to the top and bottom rails 3/4 inch diameter, hollow, utilizing nylon baluster connectors. Nylon baluster galvanized Q195 steel connectors are then attached to the top and bottom rails balusters. See Figure 3. with M4.8 x 38.1 flat-head, coated carbon steel screws. See Figure 11. Top and Bottom rails have co- extruded wood-plastic composite Nominal 1.25' square, RadianceRail° p p hollow, co-extruded PVC The top and bottom rails include pre-routed holes to Express "breadloaf' profiles (Figure 2) receive balusters. that consist of pre-routed holes baluster. Figure 4. to receive balusters. Architectural Testing 130 Derry Court• York, PA 17406 717-764-7700 www.archtest.com TOY-IN OF AUflcl,TABILE if 114 PR l 2 2 P,# 9: 2 . Jei i i i 1 E 4y ttt i ;ILA TI-ES Code Compliance Research Report CCRR-0114 Page 10 of 13 Intermediate Base Plate Intermediate Baluster Post Cap(2) es Top Rail(1) Mounting Bracket(4) n _L Support Rail(2) IP H II Post Cover(2) Support Block(4)' 1H it Bottom Rail(1) Foot Block (2 in an 8'cu5lom rail pack) Post Skirt(2)— Quick-Connect'swivel fitting Figure 10—RadianceRailo Level Assembly with Feeney®CableRailTm Baluster Connectors Post Cap(2) Top Rail(1) Mounting Bracket(4) Support Rail(2) t II Metal Baluster (20 in 8'kit) Post Cover(2) Support Block(4)' Bottom Rail(1) 6, .73 - - --------------- — — �I) 1 Foot Block (2 in an 8'custom rail pack) Post Skirt(2)— + .' s- Figure 11 —RadianceRaile Level Assembly,with Steel Balusters i Architectural Testing 130 Derry Court a York, PA 17406 717-764-7700 www.archtest.com v r tit. �' 1 7.1 CUH14t1 WAS;(7i45c-D " Lu. � �� USG-`• 1+�a/✓u^�c-�..•r N,o:�•E�f4 �KEv. /yyS�6� �/`� J :N (� O —. _j Lc�T -1 A /< PfenJFtT Mh�.4<�L �DEGK \ '- 1 \ = Q � y%`t •-}-o t' F r'G• .�4• :�3l 13c�C�,.�`\l��� \ "1 LCCp.-'f10��1g F�o�: •'PR�sE•D I\ PL,=r pi-Ao LUT '7-A s G-rrLJ IT yi p 1 f r p Ay, 51 bRES e P5A2uSTA-fly- 1= hAA---15. Ora•3E •'rj0 (Z. 7io.1//< N t O'HEhR+-J, suG., Er��T DEN►it5, ✓p'L��c+r• 00 j P.e. 1 . O Z 9 .77 tto' ---- . - q/j'8 z n n oL-Tt e-7' S_TP1/G 1 2S T b� �s z <Lor r- �7� /S7. .�. 150'FQourAE3a' - -�'/ =AT/«.NON UL moo.' F. S. �• h/.> L c�"N 771F.t/c H. 1 5' S B� S• B. �5'.UNIED PP<5TEc-noL_luQDF_-p_ �44 �. "°f '� CERTIFIED PLOT PLAN v� ROBERT BRUCE`: lei t"/� O T 77 = �a�� PiD I :8 ! p. I Dc.D 11-`i I� �`Yr.=��9i A�F 3 .t.l1`L♦`_`�'i�'.$U•��(J�e+'^�t��a ..r': .' '�!° .y< k�, _ �''e��;•J,"�'`"�I� �n � � �� �@ � �A -�'-, �� �c�, �` _ .t1... .7 �!. FF'�c- .},k �• s 5y., �_�.) .�,.Y,. �,FE�,�'•� t nix-+r 4.��^. pi � Ty 77.. � �.: .-{ , � / �{j k �):.'�'S .�'{ � aer3c r_. � � b) '• s l t �• J ... - 1... . f�JO Z 1.:.��..''r'�-,Sr_t"#t cr%•�q�A�<4�d�id�wT,: r•�'t4ky".:..3"y�{F.�44'r � ya'""dt.r"w�riv..aa��i S-�,.:. `'`"F w f �C�L Le t I_x _ -7 Q.� {d PO 0.6 8 -P �J- ' yy rp.o�m�jr/-��.t�_p—py(/�_y�(pz-a+_':./s//_�cy�� L/,�-{—�_vc/-(//^��•_yn�`/�^.[ .—_ _. _in_ �.ijSiF•-r' v.�..�w`..�'� �,.��.,�^ i...n-1 ).. h t..Y T -ll i\ 0 Y J � f r ' - .EGISTERED :: I3 OIS1'ES E SHOWN . 01-4 TH13 - PLAN IS LOCATED CI�JIL � LAHD JOB -NO. ON �'!•II~. GROUND .AS INDICATED ADD ENOlE"k ?4 = VCV® 1�P�.0°dc s�.fF:r1. CON TO T14E zoNiNo LAWS OF UARNSTABL' , MIASS.E 12" lr'iAai P•i STREET Ct!. V 04j 69 I-9 WA iV ll I.:' .k,A S S CtSb'dZ'r F of 8UR tl� 0te . C. L 0 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION ;i Map 14 Parcels Application # Health Division Date Issued OL ( a C Conservation Division Application Fee Planning Dept. Permit Fee 1 Date Definitive Plan Approved by Planning Board 12f 13 Historic - OKH _ Preservation/Hyannis lCe2 PST' X-5413Eu Project Street Address Village_ ( r_J:46 ' Owner , Address Telephone Permit Request e a b(Jwof ) c LY--c-- 1,-4 s i n ee,S� Square feet: 1 st floor: existing proposed d floor: existing proposed Total new _ Zoning District yo,i c> Flood Plain Groundwater Overlay Project Valuation o,ao*.­' Construction Type wot_� Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family a-' Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes &No On Old King's Highway: ❑Yes U(No Basement T1Ype: 16 Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) \,e,� Basement Unfinished Area(sq.ft) —a Number of Baths: Full: existing_ new Half: existing new Number of Bedrooms: 3 existing —new a Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ZGas ❑Oil ❑ Electric ❑Other Central Air: ®'Yes ❑ No Fireplaces: Existing D_ New Existing wood/coalIstove: O Yes VNo Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑existing ❑ new size_ Attached garage: P"existing ❑ new size _Shed: ❑ existing ❑ new size — Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes UK 0 If yes, site plan review# Current Use _ Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name y- Telephone Number Address License # S /Z7 �Lz v�, c�/✓ '�'� d 7 i 3 Home Improvement Contractor# �— Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO 7 SIGNATURE - DATE y FOR OFFICIAL USE ONLY APPLICATION# ,y DATE ISSUED . ` MAP/PARCEL NO. ADDRESS VILLAGE OWNER s DATE OF INSPECTION: s FOUNDATION FRAMED saz2z3 Yemck- �rF Pics- .4 INSULATION rt FIREPLACE a� ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL i GAS: ROUGH FINAL 1 . FINAL BUILDING t } DATE CLOSED OUT ASSOCIATION PLAN NO. Departrrient of Industrial Accidents. we_of lmestigatiores- — 600 Washhwton Street Boston,•MA 92111 www.mass govidia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electriciam/Plum-bers Applicant Wormafion Please Print Legibly -Name(Business%Drganizationda4ivi&4: .Address: . rf!"�s� ��� . Ci /State/Zi Are you an employer? Check the appropriate bog: Type of project(required), I.❑ I am a employer with 4. [] I am a general contractor and I _employees.(full.and/or part-time),* have hired the sub=coniractors 6 :0 New construction 2. I am a sole proprietor or partner- . listed on the attached sheep, 7. ❑Remodeling shipand have no a to ees. These sub-contractors have mP Y 8, �Demolition working for me m any capacity. employees and have wonleers' - co msurance.1 9. Building addition . [No workers'comp.�insirrance comp. . required,] 5. ❑ We area corporation and its 10.El Electrical repairs or additions 3.❑ I am a homeowner doingall work officers have exercised their 11. Plumbing❑ g repairs or additions Myself [No workers' comp, right of exemption per MGL - 12 Roof repairs inctrrance required-]t. C. 152, §1(4),and'We have no employees. [No workers' 13.❑ Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such, �Conh-actors 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-rontractnrs have employees,they mustprovide their workers'comp.policy aumbcr. I am an employer that is providing workers'compensation insurance for.my etnplayam. Below is the policy and job site information. Insurance Company Name: Policy#or Self,ins.Lid.#: 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 •mi al penalties of a . fine up to$1,500.00 and/or one year.imprisonment,as Well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification I do hereby c under the pains and penalties of perjury that the information provided above is true.and correct Si attire: Date: Pho F al use only. .Do not write in this area,to he completed by city or town official r.Town: PermitUcense# . g Authority.(circle one): rd of Health 2.Building Department 3, City/Town Clerk 4.Electrical Inspector. 5:'Plumbing Inspector ert Person= Phone#: iurru ux LaYuaLaulc Regulator_y_S.er-vices =---- =— --- --- ._ ..._• nlu�rwtti.trr XAM Thomas R.Geiler;Director � Building neon 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 Bidder I, as Owner'of the subject property hereb authorize "�� to act on m be Y y hal� in all matters relative to work authorized by this building.persnit (Address of Job) Pool fences.'aitid 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 Owner e of Applicant .. Print Nae. Print m Name L �2.rr3 Date . Q:FORvM:oWNERPERtvffSSIONPooLS 612012 ; SHE 1p 7� i wuauvauNsv . Regulatory Services sAa - xs�s, ; Thomas F.Geller,Director , p Ms&. Building Division rEn�a - . Tom Perry,Building Commissioner. 200 Main Street Hyannis,MA 02601 www.town.barnstable.ma.us . Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE MrtOTION Please Print DATE: JOB LOCATION: 1 number street.. village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: city/town . a state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license;provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside, on which there is,or is intended to be, a one or two-family dwelling, attached or detached structures accessory to such use and/or farm structures: A person who constructs more than one home in a two-year period shall not be,considered a homeowner. Such " c' n a form acceptable to the Buildin Offici that he/she shall be "homeowner shall submit to the Building Offi ial o p g �, g 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 rninirnum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official Note Tbree-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 thaf the homeowner is fuDy aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that helshe 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 fonri/ceriificationfor use in your community. Q:forms:bomeexempt Massachusetts -Department of Public Safety7. i (�\ Office of Consumer Affairs&BJsinessRegulaHon Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Construction Supervisor I & 2 Family - .TJEEYCLANCY�C0N,,-.T-R. AC,1 Registration: .,129922 Type: License: CSFA-072570 Expiration: -1i1Y2312013 DBA JEFFREY E CLAN�y ING! 2 CARLETON DID i rr -E SANDWICH N 02 JEFFREY CLANCY k t 2 CARLETON E.SANDWICH;MA 02537t_r :3' Undersecretary Expiration (..... Commissioner 09/21/2014 t ParcelEdit Page 1 of 1 _ pia —«.. Logged In As: Monday,August 5:.2013 Frank Schlegel Parcel Application Center Road System.Reports Road System The ,record has been updated, Parcel Detail , Parcel ID: 074025 „) Sewer Acct: T/R °Up to Devel Lot: ILOT 48 j Owner: JBHATT, SAMIR M &AMITA K. �. Co Owner: Street: 19 SHELLEY ROAD ...... _I City: -- - WELLESLEY 4 Stater MA! Zip: 02481 _ s Location: 62 1 F71POINT ISABELLA ROAD village Cotult Road Index: 1280 Pri Frontage 0000µ To set road,you can also enter road'index and tab out of field. Secondary Road: ILEEWARD WAY Sec Index; 0938 � sec.Frontage; 0020 visions,kocatlon: 20 LEEWARD WAY s Last update 8/5l2093 2:51 54 PM j y --------------- No. Bldgs: 1 Account No.: 38694 j Lot Size(acres): 1.03000459 .State Class: 1010 ..W Year Added: 1982 Fire Dist: 2 Deed Date:, 5/2/2012 j Deed Ref;; C196996 f Land Value:. 1D98600 ' Bidgs Value; 278900 Extra Features: 97700 _._.__. _ ... .. ... . . --------------- Condo.Complex: d... Buildsng.� 1 Unit U,p'date. http://issgl2/intranet/propdata/ParcelEdit.aspOID=4634 0/20.1`3 TOWN OF BARNSTABLE D.P.W. akQ .o o - ..- � oo— 41 oDv J Ln h. �v i N m . IINNNS� r f f j L,� COP x basemaps.dgn 8/5/2013 2:47.:14 PM am assessing and do not represent edud reloamthIpe to ptys _ I r.^ )ffice Locations for Dr. Peter E. Crosson I Internal Medicine in West Yarmouth, MA Pagel of z NEW Urgent care centers (/urgent-care) Sign up (https://my.vitals.com) or Log in (https://my.vitals.com/users/sign_in) Find a doctor or facility Write a reviev Find doctors near who acce AD%^, Get informed (/topics) Home(http:/Avww.vitals.com)> Find an Internist(http://www.vitals.comAnternists)> MA(http://www.vitals.comAocations/internists/ma)>West Y (http://www.vitals.com/internists/ma/west-yarmouth)>Dr. Peter Crosson. MD(http://www.vitals.com/doctors/Dr Peter Crosson.html)> Locatior I Peter E Crosson, MD (http://www.vitaIs.com/doctors/Dr Peter Crosso j Is this you? Claim profile(https://my.vi'tals.com/pr( Internists i Emerald Physicians f 11 years of experience { " 19 W Yarmouth Rd i #B d Accepting new patients West Yarmouth, MA 02673 508-778-4777 i Locations and availability(2) (http://www.vitals.com/doctors/Dr Peter Crosson/o G Write a Review (hftp://www.vitals.com/review/Dr—Peter—Crosson) i k i Summary (http://www.vitals.com/doctors/Dr Peter Crosson.html) Patient Reviews(http://www.vitals.com/doctors/Dr Credentials (hftp://www.vitals.com/doctors/Dr—Peter—Crosson/credentials) j Locations&Availability (http://www.vitals.com/doctors/Dr Peter Crossonloffice-locations) 1 Accepted Insurance(http://www.vitals.com/doctors/Dr—Peter—Crosson/insurance) Locations The Vitals website is only. Nothing contain Vitals should be com upon for medical dia( Emerald Physicians recommend or endor 1 19 W Yarmouth Rd Accepting new patients provider whose inforr #B website.We encoura West Yarmouth, MA 02673 Service. 508-778-4777 Get directions ittp://www.vitals.com/doctors/Dr—Peter—Crosson/office-locations 3/25/201z )ffice Locations for Dr. Peter E. Crosson I Internal Medicine in West Yarmouth, MA Page 2 of 2 Emerald Physicians Service Inc Group Accepting new patients Map 433 W Main St Hyannis, MA 02601 508-778-4777 Get directions Next:Accepted Insurance (http://www.vitals.co,m/doctors/Dr—Peter—Crosson/insurance) C rlL)V�F RT I�EMENT Similar doctors nearby Dr. Neena Chaturvedi (http://www.vitaIs.com/doctors/Dr—Neena—Chaturvedi.htm1) Internal Medicine 20 years experience Hyannis, MA Dr. Timothy Biliouris (http://www.vitaIs.com/doctors/Dr—Timothy_BiIiouris.htm1) Dermatology 24 years experience South Dennis, MA Dr. Paul Siegel (http://www.vitaIs.com/doctors/Dr—PauI_Siege1.htm1) Internal Medicine 34 years experience Hyannis, MA Dr. MARCIA BROWNE (http://www.vitals.com/doctors/Dr—Marcia—Browne.htmi) Internal Medicine 31 years experience Oak Bluffs, MA Dr. Mark Nickels (http://www.vitals.com/doctors/Dr—Mark—Nickels.htm1), Internal Medicine 14 years experience Falmouth, MA ittp://www.vitals.com/doctors/Dr—Peter—Crosson/office-locations 3/25/201� )ffice Locations for Dr. Peter E. Crosson I Internal Medicine in West Yarmouth, MA Page 3 of Dr. Arshad Mian (http://www.vitaIs.com/doctors/Dr—Arshad—Mian.htm1) Internal Medicine 9 years experience Falmouth, MA Search All Similar Doctors (http://www.vitals.com/search?type=specialty&provider type=1&q=Internists&specialist_id=110& Let us help you find and review doctors, make an appointment, and prepare for your doctor vi; About Vitals Search by: Top specialties Top conditions Tc About(/about) Specialty(/specialties) Dermatologists(/dermatologists) Asthma Aet Contact us Location (/locations) Endocrinologists(/endocrinologists) (/condition/asthma) Ant (/about/contact) Name(/directory) Family practitioners(/family-physicians) Breast cancer Blu Advertise with us Condition(/conditions) Neurologists(/neurologists) (/condition/breast- (/in (/about/services/brands- Insurance(/insurances) Obstetricians&gynecologists cancer) tex: agencies) Group practices(/group- (/obstetricians-gyneco log ists) COPD Cig For hospitals&doctors practice) Orthopedic surgeons(/orthopedic- (/condition/chronic- Gre (/about/services/for- Urgent care centers surgeons) obstructive-pulmonary- (/in hospitals-doctors) (/urgent-care) Pain management doctors(/pain- disease-copd) HIF For health plans management-doctors) Depression (/in (/about/services/health- Pediatricians(/pediatricians) (/condition/depression) yor plans) Psychiatrists(/psychiatrists) Diabetes Hui Partner with us Urologists(/urologists) (/condition/diabetes) Me (/about/contact) All specialties... 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MDX Medical, Inc. ("MDX").the provider of this website,do particular healthcare provider whose information or ratings appear on this website;and(2)MDX has granted you a limited license to access; noncommercial use.You are not permitted to copy, reproduce, distribute,transmit, mirror,frame, scrape,extract,wrap,create derivative wor or disassemble any part or aspect of this website. ittp://www.vitals.com/doctors/Dr—Peter—Crosson/office-locations 3/25/201z Message Page 1 of 1 Shea, Sally From: Shea, Sally Sent: Monday, March 24, 2014 9:38 AM To: Schlegel, Frank; Olsen, Christopher(Chief Cotuit Fire) Cc: Barrows, Debi Subject: Pleas confirm I have an applicant that has informed me that 20 Leeward has undergone and address change to 62 Point Isabella in Cotuit. I no longer see 20 Leeward in the address database. Please confirm for our records. Thank you. Sally Shea 508-862-4031 3/24/2014 COMNIONTWFALTH OF MASSACHUSETTS —E� DEI AJz_D`�N—r OF 1:\,DUSTRIAL ACCIDENTS ' SUI:f>N'CE AFFIDAVIT I, �J Y��C I< (.�1.1�•t,�dC2r/ �,.c (licensee/purnincc) With a principal place of business/residence at: (Gry/State/Zip) do hereby certify, under the pains and penalties of perjury, that: V-111,2m an employer providing the following workers' compensation coverage for my employecs working on this )ob. we, 140 -35oo0 / Insurance Con4iny Policy Numbcr O I am a sole proprietor and havc no one working for me. [ ) 1 2m 2 sole proprictor, gene.-ai eonumaor or homcowncr (eirde one) and havc hired the eontraaors listed below who havc the following workers' compensation insurance politics: Namc of Contrraor Insurance Company/Policy Numbcr Name of Contr2ctor 1:r.su-2nec Companv/Poliey Numbcr Namc of Conu2aor Insurance Company/Policy Numbcr 0 1 am 2 homcowncr performing all the work myself. NOTE Ple:.sc be ;,-a -bile boroeowners♦lio ernploy persons to do m-inten=ee,eonsiruetion or repair work on ; dwelling of no; rnorc ti:- Lrcc un;u in k�ich the borz)cowncr also res;dcs or on the grounds appurunant tbcrcto arc not gcncrJl)- eons;dcrcd to be ertp!cye:z unccr the rort ers' Cornpens:uon Aa (GL C. 152,sca- 1(5)), application by a homcowncr for a l;eCDsc or perr^it r..:y cvidc ncc Lc 1cFJ si:r s cf ti cr�loycr unccr the Woz)crs'Cornpcnut,on fsct 1 undcrst:nd that Q eof,y of Iris sr:tcr.cnt will be for..wdcd to the Depa;tmcnt of Industri.- Accidenu'Ofr,ee of Insurance for coves=c �crificat;or.aad th:; fa !c:c to:ccerc covcr-.ic as rcet:;rcd ur,dcr Sccrion 25A of MGL 152 e.:n kid to the imposition of.riJminJ penJt;cs n'Cr; r,:c er to t t c,�0.0Q:-n(/or —.Dr onr..cr cf up to ore}'c= :nd c� pcnJJes i� the form of: Stop Work Ordcr :nd fine of c 100.00'a c.v:E: r:: nc. Signcd d is ! day of_ , )9 Lice Sc Permlttee Licensor/Permittor dF� °= The Town of Barnstable MASS.a�sysTnste. , Department of Health Safety and Environmental Services '' Building Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-775-3344 Building Commissioner For office use only Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair, modernization,conversion, improvement, removal, demolition, or construction of an addition to any pre-existing owner occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions, along with other requirements. Type of Work: &'VLO Est.Cost 3S,0M Address of Work: do 4,U M /� Owner Name: //1r N rnr5 01 11IQ!'1/j Date of Permit Application: I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job under S1,000 Building not owner-occupied Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: 9 Date Contractor name Registration No. OR Date Owner's name �yXRry o� ,ti j _ Federal Emergency Management Agency Washington, D.C. 20472 �qND SF-�' September 11,2012 MR. SAMIR BHATT CASE NO.: 12-01-2322A 19 SHELLEY ROAD COMMUNITY: TOWN OF BARNSTABLE, WELLESLEY, MA 02481 BARNSTABLE COUNTY, MASSACHUSETTS COMMUNITY NO.: 250001 DEAR MR. BHATT: ©rt�� T 2p Q-- Vt��me�ti� This. is in reference to a request that the Federal Emergency Management Agency (F A) eterm if the property described in the enclosed document is located within an identified Special Flood Hazard Area, the area that would be inundated by the flood having a 1-percent chance of being equaled or exceeded in any given year (base flood), on the effective National Flood Insurance Program (NFIP) map. Using the information submitted and the effective NFIP map, our determination is shown on the attached :Letter of Map Amendment (LOMA) Determination Document. This determination document provides additional information regarding the effective NFIP map, the legal description of the property and our determination. Additional documents are enclosed which provide information regarding the subject property and LOMAs. Please see the List of Enclosures below to determine which documents are enclosed. Other attachments specific to this request may be included as referenced in the Determination/Comment document. If you have any questions about this letter or any of the enclosures, please contact the FEMA Map Assistance Center toll free at (877) 336-2627 (877-FEMA MAP) or by letter addressed to the Federal Emergency Management Agency, Engineering Library, 847 South Pickett Street, Alexandria,VA 22304-4605. Sincerely, Luis Rodriguez,P.E., Chief Engineering Management Branch Federal Insurance and Mitigation Administration LIST OF ENCLOSURES: LOMA DETERMINATION DOCUMENT(REMOVAL) cc: State/Commonwealth NFIP Coordinator '"' Z4 Community Map Repository n Region , a _ --t Page 1 of 2 Date: September 11, 2012 Case No.: 12-01-2322A LOMA vv4A�\�,r Federal Emergency Management Agency so- Washington,D.C.20472 l�,v o sEc LETTER OF MAP AMENDMENT DETERMINATION DOCUMENT REMOVAL COMMUNITY AND MAP PANEL INFORMATION LEGAL PROPERTY DESCRIPTION TOWN OF BARNSTABLE, Lot 48, as described in the Quitclaim Deed, recorded as Document BARNSTABLE COUNTY, No. 1190619, in the Office of the Registry of Deeds, Barnstable MASSACHUSETTS County, Massachusetts COMMUNITY COMMUNITY NO.:250001 NUMBER:2500010018D AFFECTED MAP PANEL DATE:7/2/1992 FLOODING SOURCE:NORTH BAY;NANTUCKET APPROXIMATE LATITUDE&LONGITUDE OF PROPERTY:41.632, -70.413 SOUND SOURCE OF LAT&LONG:STREETS&TRIPS 2010 DATUM:WGS 84 DETERMINATION OUTCOME 1%ANNUAL LOWEST LOWEST WHAT IS CHANCE ADJACENT LOT LOT BLOCK/ SUBDIVISION STREET REMOVED FROM FLOOD FLOOD GRADE ELEVATION SECTION THE SFHA ZONE ELEVATION ELEVATION (NGVD 29) (NGVD 29) (NGVD 29) 48 t 20 Leeward Way Structure B 11.0 feet 11.6 feetI I I I F - Special Flood Hazard Area (SFHA) - The SFHA is an area that would be inundated by the flood having a 1-percent chance of being equaled or exceeded in any qiven year(base flood). ADDITIONAL CONSIDERATIONS(Please refer to the appropriate section on Attachment 1 for the additional considerations listed below.) PORTIONS REMAIN IN THE SFHA STUDY UNDERWAY This document provides the Federal Emergency Management Agency's determination regarding a request for a Letter of Map Amendment for the property described above. Using the information submitted and the effective National Flood Insurance Program (NFIP) map, we have determined that the structure(s) on the property(ies) is/are not located in the SFHA, an area inundated by the flood having a 1-percent chance of being equaled or exceeded in any given year (base flood). This document amends the effective NFIP map to remove the subject property from the SFHA located on the effective NFIP map; therefore, the Federal mandatory flood insurance requirement does not apply. However, the lender has the option to continue the flood insurance requirement to protect its financial risk on the loan. A Preferred Risk Policy (PRP) is available for buildings located outside the SFHA. Information about the PRP and how one can apply is enclosed. This determination is based on the flood data presently available. The enclosed documents provide additional information regarding this determination. If you have any questions about this document, please contact the FEMA Map Assistance Center toll free at (877) 336-2627 (877-FEMA MAP) or by letter addressed to the Federal Emergency Management Agency, Engineering Library, 847 South Pickett Street, Alexandria,VA 22304-4605. Luis Rodriguez,P.E.,Chief Engineering Management Branch Federal Insurance and Mitigation Administration Page 2 of 2 Date: September 11, 2012 Case_No.: 12-01-2322A LOMA s Federal Emergency Management Agency Cwr a 3Ft �a` Washington,D.C. 20472 ND 5 LETTER OF MAP AMENDMENT DETERMINATION DOCUMENT (REMOVAL) ATTACHMENT 1 (ADDITIONAL CONSIDERATIONS) PORTIONS OF THE PROPERTY REMAIN IN THE SFHA (This Additional Consideration applies to the preceding 1 Property.) Portions of this property, but not the subject of the Determination/Comment document, may remain in the Special Flood Hazard Area. Therefore, any future construction or substantial improvement on the property remains subject to Federal, State/Commonwealth, and local regulations for floodplain management. STUDY UNDERWAY (This Additional Consideration applies to all properties in the LOMA DETERMINATION DOCUMENT (REMOVAL)) This determination is based on the flood data presently available. However, the Federal Emergency Management Agency is currently revising the National Flood Insurance Program (NFIP) map for the community. New flood data.could be generated that may affect this property. When the new NFIP map is issued it will supersede this determination. The Federal requirement for the purchase of flood insurance will then be based on the newly revised NFIP map. This attachment provides additional information regarding this request. If you have any questions about this attachment, please contact the FEMA Map Assistance Center toll free at (877) 336-2627(877-FEMA MAP) or by letter addressed to the Federal Emergency Management Agency,Engineering Library,847 South Pickett Street,Alexandria,VA 22304-4605. Luis Rodriguez,P.E.,Chief Engineering Management Branch Federal Insurance and Mitigation Administration Town Of Barnstable *Permit#.QD- �(�1 Expires 6 m onfiis from issue date Regulatory Services Fee Thomas F.Geiler,Director Building Division Tom Perry,CEO, Building Commissioner r/ ` 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-62 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY �j yl Not Valid without Red X-Press Iinprint Map/parcel Number Property Address U A)6/w residential Value of Work i' Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address O Contractor's Name 1— • �J 'l,�h Telephone Number Home Improvement Contractor License#(if applicable) Construction.Supervisor's License#(if applicable) UU 302 21gorkman's Compensation Insurance -PRESS Check one: XS PERMIT ❑ I am a sole proprietor 0 C T 2 0 2009. ❑ I am the Homeowner (al have Worker's Compensation Insurance TOWN OF BARNSTABLE Insurance Company Name �' � . CC Workman's Comp.Policy# Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) B-Iie-roof(stripping old shingles) All construction debris will be taken to 1/ ❑Re-roof(not stripping, Going over existing layers of roof) ❑ Re=side - ❑ Replacement Windows/doors/sliders. U-Value (maximum.44) "Where required: Issuance of this permit does not exempt compliance-Aith other town department regulations,i.e.Historic,Conservation,etc. r�s ***Note: - Property Owner must sign Property Owner Letter of Permission. c of the Home Improvement Contractors License is required, o v C-) r' SIGNATURE: tv Q:Fonns:expmtrg CD Revist061.306 .. GrJ Department of industrial Accidents Office of Investigations ' d 600 Washington Street J,= Boston,M4 02111 www.mas&gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers ,,pplicant Information j Please Print Legibly 'Jame(Business/orpnization/Individual): 7�-� r ��( y 16C address: 4 6 a c— :ity/State/Zip: 6L tl F1 I S. 64R Phone#: 6;;� re you an employer?Check the-appropriate box:. -ram a employer with �� . 4. ❑ I am a general contractor and I Type of project(required): t- 6. ❑New construction employees(full and/or part-time)-* have hired the sub-contractors 7 I am a sole proprietor or partner- listed on the attached sheet:I ❑Remodeling ship and have no employees These sub-contractors have S. ❑ Demolition working forme in any capacity. workers' comp,insurance. 9 ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑ Electrical repairs or additions I am a homeowner doing all work right of exemption per MGL 11.0 Plumbing repairs or additions myself.-[No workers' comp. c. 152, §1(4),and we have no 12.❑ Roof repairs insurance required.] t employees. [No workers' comp.insurance required.] 13 ❑ Other y applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information: a meowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such itractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy inforrnation. n an employer that is providing workers compensation insurance for my employees Below is thepolicy and job site ormation. trance-Company Name: cy#or Self ins.Lie.#: l tea do 2 Expiration Date: C33&.1 d l Site Address: - 'a - AJk&C; City/StateJZip: m, 0Po 3S tch a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). are to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a up to$1,500,_00 and/or one-year imprisonment,as well as,civil penalties in the form of a STOP WORD ORDER and a fine p to$250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of - stigations of the DIA for insurance coverage verification. hereby certify u e pains and penalties of perjury that the information provided above ' true and correct afore: Date:' skid use only. Do not write in this area,to be completed by city or town of xiaL Ity or Town: Permit/License# ;suing Authority(circle one).- Board of Health 2.Building Department 3.City/Town-Clerk 4.Electrical Inspector 5.Plumbing Inspector Other ontact Person: Phone#: Date: 2/20/2008 Time: 4:04 PM To: R 9,15087754909 Page: 002 Client#:2093 2JAXTIMEREJ ACORD. CERTIFICATE OF LIABILITY INSURANCE M�°rrm PRODUCIER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Dowling$O'Neil Insurance ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER,THIS CERTIFICATE DOES NOT AMEND,EXTEND OR Agency ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 973 lyanough Rd., PO Box 1990 Hyannis,MA 02601 INSURERS AFFORDING COVERAGE NAIC# INSURED mantm A. Acadia insurance E.J.Jaxdmer Builder, Inc. INSURER B: F ireman's Companies Emest J.&Marie T.Jaxtimer nNstRssN C: 48 Rosary Lane Hyannis,MA 02601 INSURER D: INSURER E: COVERAGES 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 DESCRB®HEREIN iS SUBJECT TO ALL THE TERMS.EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAiD CLAIMS. TYPE IM10E POLICY NUt�HN POLICY EFFECTIVE POLICY EXPIRATION LTR DATE UNMIUMM DATE LINQTS A GENERAL LL40R Y CPA010264814 01101/08 01/01/09 EACH OCCURRE NCE. $1 000 000 ---------- _ _ DARAAGETOREN M f...�3-CLAWMADE a DcwR HIED-EXP-On am pw= PERSONAL a ADV INJURY $1000 000 GENERAL AGGREGATE $2 000 M GWL AGGWGATE LMrT APPLIES PER. PRODUCTS-COUPIOP AGG $ 000 000 POLICYPRO.- ZCT F1 LOC B AUTOMOBILE LrasLm MAA010395014 01101108 01/01109 COyB84ED SINGLE LIMrr ANYAUFO (Ea-ddwd). $1,000,000 ALL OWNED AUTOS BODILY INJURY X SCHEDULED AMOS (Perp—) $ X HBREDAUFOS BODILY INJURY $ X AUTOS (POaeddent) PROPERTYtDAMAGE $ GARAGE LIABILITY AUTO ONLY-FA ACCIDENT $ ANY RAO OTHERTHAN EAACC $ AM ONLY: AGG $ A EXCESSA110BRELLAILMMM CUA010264914 0110110E 01/01109 EACH OCCURRENCE $2 000 000 31 OCCUR ❑CLAIMS MADE AGGREGATE s2,000,000 $ HnBLE $ X RETENTION $0 $ A warlmtsc AT=AND WCA020455011 01IM1108 01/01/09 WC STATLL On+ ER EMPLOYERV LIABLnY ANY PRDPR1ETOWPARTNERIEX CUTIVE E.LEACHACGDENT $501},000 OFFICERIMEMBER EXCLUDED7 NO F-L DISEASE-EA FMPL $=000 3PEC'IAL PRovEs 0'm babN E.L.DISEASE-PLAJCY LIMB sW0 000 OTHER DESCRIPTION OF OPERATIONS i LOCATIONS I VEHICLES I EXCLUSIONS ADDER BY ENDOR5QUENT I SPECIAL PROVISIONS Certificate holder is named additional insured for general liability. E.J.and Marie Jaxtimer are included under the workers compensation policy. . Operations performed by the named insured subject to policy conditions and exclusions. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLigES BE CANCELLED BEFORE THE EXPERATW N Town of Barnstable DATE THEREOF,ME ISSUING INSURM V&L ENDEAVOR TO MAIL _11L DAYS WRITTM 200 Main Street NOTICE TO THE CERTIFICATE HOLUM UMM TO THE LEFT.BUT FAILURE TO DD SO SNAIL Hyannis,MA 02601 RMWE RD OBUGATM OR LIABam OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENrATWES. AUTHORIZEDRCSENTA ACORD 25(2001108)1 of 2 #S50995/M50595 LS1 ®ACORD CORPORATION 1988 Town'of Barnstable Regulatory Services 9 Thomas F.Geiler,Director 1639. wilding Division. Tom Perry, Building Commissioner 200 Main Street; Hyannis,MA 02601 ffice:. 508-862-403 8. Fax: 508-790-6230 Property Ow aer Must Complete and Sign This Section If Using A Builder I , as Owner of the ect sub' l property hereby authorize -J Ij - - G' )b rto act on my behalf, in all matters relative to work authorized by this building p ermit application for. (WiN (Address of Job) 'IV lobo bo $' `e lof E}wner Date . Print Name Q:FORMS:OWN-ERFERNIIMSION.' l �� Board of Building Regula ions and Standards One Ashburton Place Room 1301 Q" Boston, Massachusetts 02108 Home ImprovementContractor Registration Reqistration: 110609 Ir; Type: Private Corporation 1 f r Expiration; 11/3/2008 Tr# 124739 JA ERNEST. JAXTIMER ER BUILDER INC. .f 48 ROSARY LN a _ ----.. HYANNIS, MA 02601 rt a.a .y Update Address and return card. Marls reason for change. Address Renewal Employment Lost Card DPS-CA1 0.5OM-05/06-PC8490 - - -- - -- - ------------- /t } ✓lee -Po7.vyw�t.,uealtl a� ��a�ia�ccl uaelza � � jj g g 1 i Boalyd of Bwidm Re ulahons and Standards Constructlon Supervisor License ' L-icnse CS f t I{ {Xxp'l atron 1/114/2010 Tr# 13629 klest trlCiOrl l{ EE lki =g i- f - i. ERN ST 48 ROSARY HYANNIS MA 026a1 Commissioner` TOWN OF BARNBTABLE Permit No. _ 24208 Building Inspector' Cash 80. UL r OCCUPANCY PERMIT Bona No building nor structure shall be erected, and no land, building or structure shall be used for a new, different, changed, or enlarged use without a Building Permit therefor { first having been obtained from the Building Inspector. No building shall be occupied until a certificate of occupancy has been issued by the Building Inspector." Issued to .Barbara J. Murphy' Address �p Lot: VA, ,,20 Leeward ray, Cotuit a_ Wiring Inspector , YV �� � it e'I Inspection date A7, Plumbing EaspeCtor )Illy Inspection date Gas Inspectors Inspection date :Engineering Department i.,-�yr - 'Y ,r Inspection date * _3 ~- .//"�t _ 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. Building,,'Inspector y `ssor's map and lof''numbe .' ....� 9. .a�....... 4� ,t "�� : ' gA � PTiC SYSTEM MUST'SE • �/�� �.�(���c.5 s�,lg� INSTALLED IN:COMPUi4NCE �NTA6E Sewage Permit number ........................... WITH TITLE 5 + tit D r4JVF' " onf'� ENVI N f7HE O r aBARIT TOWN _ COMMISS10N l .fie- 3-: i BBHBSTADLE, i 9 BUILDING INSPECTOR �E0 M Or APPLICATION FOR PERMIT TO .... ...`...`..Sf......`� ck .. `�'^"x'4"....I � ••••...................... .......... . ......... ............. . ..... .... . �� E TYPEOF CONSTRUCTION ......... ....►-A .....................................................................:....................... ...... ,.S .................19.g TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit acc di to the following infopetion: Location ........�-a.r...yA......(G�-J Cot, �ls `f ['r:.. S.6 . `{�� P.....��.�.._.....l as`rvtr � u?SS :............................. Proposed Use �.. . Svc Vc51cQc................................................................................................................ � L Qi1M .......,..... ....... ........... . Zoning istrict ...... ....................... ......................Fire District ......C�cr io�� o �iQ flee ✓ !f Gc �... �......... .9a All Name of Owne Nameof Builder . ...............^.#..-.......,.............:..........................Address .................(................................t......:................................ Name of Architect �AvtcQ 6Q ��e�u� c(Sb U\l1/ g...�lcpc 6��Uhi7UtS �l►1 �L.L Address ¢-V' .............................. .............. .................. ........ 7 Foundation ... bC�Ve , C��' Number of Rooms .......................................... Exterior ...uo . !� � 1e Vk....Roofing .... �� OVC040-� Cs �`. ............ � Floors 1 U00 p r Interior ....��a�C.AO.A.ta 11............................................................... Heating v......� ...::........................:Plumbin Fireplace ........ .......................Approximate Cost ........... ............�.Qec7.................... ...:........ Definitive Plan Approved by Planning Board 'L Definitive Q_ . Area .....�....���D` .................... Diagram of Lot and Building with Dimensions ee ........�c�l.. .... ................. SUBJECT TO APPROVAL OF BOARD OF HEALTH ©. 0 ID �65 I_o-r 4$ (.7?� t ,oz7 Ica@S 113 30� e 300` 1'77, 13 L� IJ . 1; •1 fir• �rsA�3�L�A (�ol�� . I hereby agree to conform to all the Rules and Regulations of the Town of nsta 1 regardpig the abo construction. e w (i Name ........ .......................................... y. 11F r. PHY, BARBARA J. 1� Story �- ,.o Z4208 Permit for ....a............................. Sing. ....le Family. . ...D...welling ..... .... .... .. ....... .. Location ,Lot VA 20 Leeward Way, ......... .......... ..... i Cotuit ........................................................ ................... Barbara J. Mur n Owner ........................................3,?..y.................. Type of Construction ... ame .............................................................................. _ Plot ........... ............... Lot ................................ •i , July 13, Permit Granted ..................................... 19 82 ~ K Date of Inspection .......................19 } Date Completed ......................................19 PERMIT REFUSED 1 k ................................................................ 19 ..................e .... ...... . ............. a '� .......4... + :.'................................... ................. �. 1 Appro .............................................. 19 .............. ........... ..........................:.................................................... 1, Assessor's map and lot number` .. �..�....... . '......... . ...... ' c. 4'•'!� f4,C...� � � � •.•• _- tits-'t;••i SeWage Permit number ..... / t.............................................. THE TOWN OF BARNSTABLE TO� _ •I n �J tSo�'Q f� i BARNSTABLE, i t. L: E s639. 04 BUILDING INSPECTOR I • C 1'L:` T�tJ.-J� 19- •.iL.4!.�vl�... I APPLICATION FOR PERMIT TO ...............+...'.............................I................................................................. ............ - t TYPEOF CONSTRUCTION .......... .0r.n .�tA�`�' '-'........................................................................................................... ................................................ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: ' r I 1 ;�` 66,f psi :r '� It 1,r yi l' +'1 L I , Location 1 . `............. r...- r r A z 17 '.,T I�f h4��..:.......................... .............................. .4. ...... ........ ...... .... .. .. .... h r '• Proposed Use .........�= ......� ................. -; ..........................•.,.I i'f:,I..i............................... ..... .. .. , ................................................:.................. ....... Zoning District, tt ......Fire District .......E t :: ... _ Name of Owner. ..{. � }�� il/t 3 k f ti f 4l = ..A�ddreSS .'�:: _T It 'C .``At ...?...; irt!........... .. ...... .. .. ..... ...... ... ... ...... . ... f1 Name of Builder ..` ................... -__ ._ __ ,_ .......... ............................................... 3 c F rt `�?......................... .Address ':.` :. �.`'' ----- �� 4 Name of Architect r,JV{fv `•�:'t' Y1. Address '151' � '1;I.►" ' 1�1 `3' itT►t ...,,AV...... ...... ......................................... ..................................................................................... i` Number of Rooms, ....Foundation .,r.s.......t.................I Exterior ...`:}'Y f.%........:'t�.�cr �. Y/r . _. �.7.,`.. OOfI g .....`. .. .}..... �;�vl 0 ........ ..... .... �..I� t s� .... . +. ................:R n .... . .. Floors .. ...................................Intenor Heating_ ....... ......... _....... ......... ........ .-.......... .Plumbing, ..... ...........................................................1 ` .. .. Fireplace t:r'.y .. ....:.Approximate Cost .....r*..........z........:::........ ................... Definitive Plan Approved by Planni - f N ng-Board �.zt1t 19 - Area . ` 7 : - - -- Diagram of :Lot and. Building with Dimensions ,.,'. Fee. ............".:".::.......................... SUBJECT TO APPROVAL OF BOARD OF HEALTH ' o -'----•�.;�,:�..�,_:..,.._,.�.-':.��.�.:-�--�.- -- s. - __ ; . -m.. ._ __-- _ , .. _ - �- III 17 t I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above r ` construction. r ? Name ....................... .... ............ ..................... MURPHY, BARBARA J. A=- 1--9--- `1 No 242 0.8.:.. Permit for l i Story Single Family Dwelling ............................................................................... Location Lot #7A......20. ....Leeward. . . . .:.Way. .... .. .. . .. .... .. .... .. .. .... Cotuit ..............................................: :.............................. J1 Owner „Barbara. ... ...,Murphy J. Murphy T .... ..... ..,.................................. Type of Construction Frame /................. ............... ..................................... � ....,. ................., ............... Plot ......................... . Lot .......... . ................. J Permit Granted ...... ......y.......3...,.....t..........19 82 Date of Inspection .... .................. .........19 Date Completed .. ... ..............................19 PERMIT R USE > 19 .....c. . .�. ...... .. ... .... Mo (433 h ..................................... .......................................... ............................................................................... ............................................................................... Approved ................................................ 19 ............................................................................... ............................................................................... } Assessdr s map and lot number ... ...... �F THE t0 ' Sewage Permit number ................F....................................... BARNSTABLE, i .HoLAe number .......................................................................... roAea 0� M : O 1639 \0 E VIR a• TOWN ,OF BARN,STABLE = ' 'BUILDING INSPECTOR .-APPLICATION FOR PERMIT TO ............ \ .............. .... .$. ........................... ... ........................... 'TYPE OF CONSTRUCTION ..............................................' .. ............... .........../.../../f.. .....................................(\..��../1� TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a�ermit accordi g to the folloyvipg information: cl Location ........................... ProposedUse ................................................................................................................................... ZoningDistrict ............................Fire District ........�.�'............................................................. Nameof Owner ... . .... .. 0...... .. ..... .......... ........ :.....Address ................:.................................................................... ' Name of Builder :.. . .I...... .. . ,..... ...:... ....-... ....Address .................................. V Nameof Architect ...................................................................Address .................................................................................... Number of Rooms .........;. ................................foundation Exierior ..............................................................................:......Roofing .................................................................................... Floors .Interior ..................................:.:............................................... .............':. .................. ......:Plumbing ....y...............`............................................................. J Fireplace ...................................................................::.............Approximate Cost Definitive Plan Approved by Planning Board ________________________________19________. Area .......................................... Diagram of Lot and Building with Dimensions Fee................ SUBJECT TO APPROVAL OF BOARD OF HEALTH I.hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Na .. -- ........... .. ... ..... ..................... c MURPHY, BARBARA J. 1 No .��. .`....5x... Permit for ,Demolish.............. Y............... GARAGE _. -Location ."..c' . ..........�"',,..,..Isz:bella Dr. ..............co.tui-t......... ..................................... bara J Mur h Owner ..�?.T:.......................... P...Y.......:............ x -Type of Construction ..ZKAT Re.......................... Plot ............................. Lot ................................. Permit Granted ......: 4e' tober.... g 0 Date of Inspection ...........19 _ Date` Completed t •-- � ram. i1 PERMIT REFUSED , L ............................................................... 19 � ti ; ............................................................................... ............................................................................... r , ...................................................... '...... _ ✓ ............................................................................... Approved ................................................ 19 ..`.......................'.................. ......................... / , 41, Assessor's map and lot number ............................................. OF THEtC Sewage Permit number ........................................................ row Z EARNSTADLE, i House number .............................. °o MABE 0� a mix M TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO \ �' I �r - �� . .............................................................. . .................................... TYPEOF CONSTRUCTION ..................................................................................................................................... � ..�'.:.... ............19....�6 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following�information: �� Location ........................... !} ..te�+� -Cl f ...: ..................................., ` - G�C(/1 ............................. ProposedUse .................................................................................................................................................. ......................... ZoningDistrict ...................,�` ... .....................................Fire District ....... .. ............................................................. Nameof Ownerj ........................I.......Address .................................................................................... Nameof Builder ......................................°.............. Address .................................................................................... Nameof Architect ..................................................................Address .................................................................................... Numberof Rooms ..................................................................Foundation .............................................................................. Exierior ....................................................................................Roofing .................................................................................... Floors ..........................................................Interior ............. Heating ..................................................................................Plumbing .................................................................................. Fireplace ..:...............................................................................Approximate Cost .................................................................... Definitive Plan Approved by Planning Board ________________________________19________. Area .......................................... Diagram of Lot and Building with Dimensions Fee .............................................. SUBJECT TO APPROVAL OF BOARD OF HEALTH A I 4 ,I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name f�iJ �-�... 1.,/../ �.4 -J.... ................... ---I$URPHY, BARRjARA J. A=7 4,— 21 -7 q No 22.559,... Permit for ... ........... ................. C Isabella Dr. Location .............................................................. Cotuit ............................................................................... Barbara J. Murphy Owner .................................................................. Type of Construction ....Frame......................... ................................................................................ Plot ............................ Lot ................................ Permit Granted ......Qct.o.bex...2.1.........19 80 Date of Inspection ....................................19 Date Completed ......................................19 PERMIT RE D-' ..................................... PERMIT............ .RE F E F 9....... ....... .....................\j ....................... .......... ......................................... ............ .......................... ............. .......................... .................................................... ......................... Approved ............................... ................ 19 .................... ................. ............................. ......................................................... ............................. THE FOLLOWING IS/ARE THE BEST . IMAGES FROM POOR. QUALITY ORIGINAL (S) I M X L DATA n e tv , /ivLFT �r op / J7 7. \` 'L