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0664 POPONESSETT ROAD
14 Poftodlef,nel eQ06 o �I i = ' TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION ff 1 Map Parcel Permit# c �C� Health Division Date Issued Conservation Division Fee Tax Collectox._ 7 tx Treasurer Planning Dept. Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis i Project Street Addres 7 D Village Owner ty C kQ Address Telephone .4 1�"�OKJ Permit Request Square feet: 1st floor:existing proposed 2nd floor: existing proposed Total new Estimated Project Cost QVV Zoning District Flood Plain Groundwater Overlay Construction Type Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family 011 Two Family ❑ Multi-Family(#units) Age of Existing Structure c Historic House: ❑Yes ❑w On Old King's Highway: ❑Yes W f o 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 r Heat Type and Fuel: ,❑Gas ❑Oil ❑ Electric, ❑Other Central Air: ❑Yes ❑No Fireplaces: Existing ' New Existing wood/coal stove: ❑Yes ❑No Detached garage:❑existing ❑new size Pool:O existing ❑new size Barn:❑existing ❑new size Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization • ❑ Appeal# Recorded O" Commercial ❑Yes ❑No If yes,site plan review# Current Use �. Proposed Use �� BUILDER INFORMATION zv Name Telephone Number Address �� > � License# O C13_7 CiCS Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO c SIGNATURE DATE -' FOR OFFICIAL USE ONLY PERMIT NO. `7 DATE ISSUED l" , MAP/PARCEL NO. ADDRESS ^VILLAGE '. OWNER__ DATE OF INSPECTION FOUNDATION FRAME ,r - INSULATION FIREPLACE k r. ELECTRICAL: ROUGH 1 }FINAL PLUMBING: ROUGH ' ' FINAL T GAS: ROUGH - FINAL t FINAL BUILDING ~ ft r�_ r• DATE CLOSED OUT t { r f X. ASSOCIATION PLAN NO. ' 1 • The Commonwealth of Massachusetts Asa Department of Industrial Accidents ONCe nfhsestigations 600 Washington Street Boston Mass. 02111 Workers' Compensation Insurance Affidavit- icsn ; %%/,%%/ name: ! 4 location- city (f phone�! ❑ I am a homeowner performing all work myself. ' ❑ 1 am 1 sole fro rietor and have no one workin in any ca acity Q,f am an employer provi 'n workers' compensation for my employees working on this job. com nnv name: s address: city hone#: insurance co. G ��� oiicv# ❑ I am a sole proprietor, general contractor, or homeowner(circle one)and have hired the contractors listed below who have , the folloning workers' compensation polices: companv name• address: :•::•;: :...: dtv- phone#r insarnnce cn. DORV camnanv name- address- ... cif`- phone#� insurance co. oiicv# ;:.::•:.::<,._ .....,:: Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a tine up to S1.500.00 and/or one years'imprisonment as well as dvil penalties in the form of a STOP WORK ORDER and a tine of 3100.00 a day against me. I understand flat a copy of this statement may be fo ed to the Office of Investigations of the DIA for coverage verification. I do hereby certi under p tejlofperiw�yt,hat the i ► i provided above is true mida eet DateSignature _ r Print name l✓ Phone# ofIlcial use only do not write in this area to be completed by city or town oflltial city or town: permit/Hcense q ❑Building Department ❑Licensing Board ❑check if lttftttediate response is required ❑Selectmen's Oftlee ❑Health Department contact person: phone#; 'Other (m-yu 9,95 P1A) Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the "law", an employee is defined as every person in the service of another under any coati 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 receive: 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 section 25 also states that every state or local licensing agency shall withhold the issuance or renews: 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,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 in the workers' compensation affidavit completely, by checking the box that applies to your situation and supplying company names, address and phone numbers along with a certificate of insurance as all affidavits may be submitted to the Department of Industrial Accidents for confirmation of instumce 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. City or Towns 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 applicart. PIease be sure to fill in the permit/license number which will be used as a reference number. The affidavits may be returned io the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation 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 Me of Imt8st10adons . 600 Washington Street Boston; Ma. 02111 fax#: (617) 727-7749 phone #: (617) 727-4900 ext. 406, 409 or 375 The Town of Barnstable -� M 1m Department of Health Safety and Environmental Services Building Division ► r 367 Main Street,Hyannis MA 02601 Office: 508-8624038 Ralph Crossen Fax: 508-790-6230 Building'Commissioner Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,'repai%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 Tesidence or building be done by registered contractors,with certain exceptions,along with other requirements. Type of Work: ' Estimated Cost og Address of Work: Owner's Name: G� Date of Application: `o / I hereby certify that: Registration is not required for the following reason(s): C]Work excluded by law Job Under$1,000 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 P a permit as the agent of th4vner. , VL cd:- -Ilaz 9 y Date C ntractor Name Registration No. O Date Owner's Name q:forms:Affidav THE FOLLOWING I,S/ARETHE BEST IMAGES FROM POOR QUALITY ORIGINAL (S) M A- DATA r ter. � br�+��P.�'4 ���'�'� ��y�y"g�£.+d�S�{^' #� @ '+LHb'•� d +,� l H: * +may • - k t�'.i... E�� V a �,� $3a 7°..t ,SB ;��#+ *s.'I,E4 '1 ti PAW F '��'.ca k�t� - � e�'� 'ti+s la��, 'H � Y � � r tt � � xs f ;i` a� ti�t0i y � +^. 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' ,; ;a .J�a' +� x�"k,F;,/ '° '} 1 rk•,. ,.,�x .-9lae �omr�.aonuea/!�c �acluraelta DEPARTMENT OF PUBLIC SAFETY " CONSTRUCTION SUPERVISOR LICENSE Nueber:-� Expires: �' pins: t H* Restricted To 00 i CURTIS p' fRU21EiTI {,I 28 FERNOflLf RD.. � � HYANNIS, .MA 02601 RESIDENTIAL ADDITIONS OR ALTERATIONS If located: ` ❑ North of Route 6 - any work visible from outside- needs approval from OKH ❑ In Hyannis - If work visible from outside- Check to see if it's included in the ❑ Hyannis Historic Waterfront District- if so it needs approval from them APPLICATION PACKAGE MUST INCLUDE: [� Map/parcel number Approval Sign-offs from: 0 Health ❑ Conservation(if exterior work) ❑i Tax Collector [� Treasurer ❑ If ZBA.relief(Special Permit or Variance is required for project: ❑Copy of ZBA Decision ❑Documentation proving that decision was recorded at the Registry of Deeds w/in one year of ZBA decision date. ^ / Street address FOwner's name & address VPermit request- full description of proposed proj ect(U-value of replacement windows if applicable) ❑ Square footage -proposed project Estimated project cost ❑ y Complete Dwelling information for Assessor's Office 1 Builder's information Signature ❑X Plot plan ❑ 4 sets of reduced (8.5" x 11: or 8.5"x 14")plans with cross section, framing schedule & smokes Home Improvement Contractor's Affidavit Worker's Comp form must include: Insurance company's name &Worker's Comp policy number ❑ Energy Compliance Form Copy of Construction Supervisor's License & Home Improvement Specialist's License OR❑ Homeowner's License Exemption Form. ❑ Fee z "� CHIMNEYS ❑ Need Home Improvement License ❑ No plot plan required PIERS & DOCKS ❑Need Construction Super license AND Home Improvement License Owner cannot pull own permit q-forms-PERMITS I Rev3/5/99 En Xineering Dept.(3rofloor) Map Parcel Permit# House#r (o CP Q-2 5, Date Issued - ~ 9 Board of Health(3r oor)(8:15 -9:30/1:00-4:30) `�� —�Lf( : _Fee9�� !� Conservation Office(4th floor)(8:30- 9:30/1:00•-. 2:00) 1 i 0 In Planning Dept.(1st floor/School Admin. Bldg.) �THE rq Definitive Plan Approved by Planning Board 19 �. BARE. MASS. Pdress TOWN OF.BARNSTABLE.• 'wilding Permit Application Project Stre Village ~ C 1 G 1' "+ �1.� v Addre�Owner � c�� �S Telephone d rmit Request Oo f Lz,i First Floor square feet Second Floor r�� square feet Construction Type ® � Estimated Project Cost $ Zoning District Flood Plain Ald Water Protection Lot Size 15 57)el IrO Grandfathered ❑Yes ❑No Dwelling Type: Single Family &-' Two Family ❑ Multi-Family(#units) Age of Existing Structure 9(�9, \ t/e< 5Historic House ❑Yes aXO On Old King's Highway ❑Yes ob4r" Basement Type: ull ❑Crawl alkout ❑Other Basement Finished Area(sq.ft.) X71210D Basement Unfinished Area(sq.ft) 'C� Number of Baths: Full: ' Existing �3 New d Half: Existing New No.of Bedrooms: Existing New Total Room Count(not including baths): Existing New First Floor Room Count Heat Type and Fuel: as ❑Oil ❑Electric ❑Other Central Air �es ❑No Fireplaces: Existing New Q Existing wood/coal stove ❑Yes Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) 2- ttached(size) ❑Barn(size) ❑None ❑Shed(size) ❑Other(size) Zoning Board of Appeals Authorization L3. Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# Current Use Ife 5 , Proposed Use Builder Information Name Telephone Number Address License# Home Improvement Contractor# Worker's Compensation# NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE -ATE B 4%WQ_ E F LOWING REASON(S) (At�— FOR OFFICIAL USE ONLY _ PERMIT NO. DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER ,rt... DATE OFINSPECTION: s. r Ad, FOUNDATION FRAME INSULATION r• FIREPLACE ELECTRICAL: ROUGH r FINAL'. $ PLUMBING: ROUGH FINAL GAS:= ROUGH FINAL FINAL BUILDING ',) DATE CLOSED OUT, { ASSOCIATION PLAN NO. s :s 31-7 Ive IV x PA K,4 .c A T � -47 A of wioeel eilel s Eel' e nleSs Xi S v0 R- f lee move k J 9- y IledO 0 V, / Div i4ll S New w�11S . (�?outvd Stlot ` t ' r 60 k° °`fit III fk yo � .�qx � Aldlf Mow Vo foe;S Xi;�` � � o� C .C) N � �. i'1/(o v k --�, CIL fy pt �ze� o S -rove- 57 N f 0 6 t s r d---- ._k �eryl 0 vie • TOWN OF BARNSTABLE . BUILDING DEPARTMENT HOMEOWNER LICENSE EXEMPTION Please print. • DATEClY K, 1-2 JOB LOCATION Number Street address Section of town "HOMEOWNER" � � . . c� �' � 5 Name Home phone Work phone . . PRESENT MAILING ADDRESS City own State Zip codE The current exemption for "homeowners" was extended to include owner-occupi dwellings of six units or less and to allow such homeowners to engage an ir dividiial 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 r side, on which there is , or is intended to be, a one or two family dwellinc attached or detached structures accessory to such use and/or farm structure. A person who constructs more than one home in a two-year period shall not b, considered a homeowner. Such "homeowner" shall submit to the Building Of on a form acceptable to the Building Official, that he/she shall be respons'. for all such work performed under the building permit. (Section 109 . 1. 1) The undersigned "homeowner" assumes . responsibility for compliance with the Building Code and other applicable codes, by-laws, rules and regulations. The undersigned "homeowner" certifies twat he/she understands the Town of arnstable Building Department minim in pection procedures and requirement nd that he/she will comply w' cedures and requirements. OMEOWNER'S SIGNATURE PROVAL OF BUILDING OFFICIAL ote: Three family dwellings 35 , 000 cubic feet, or larger, will be require: 0 comply with State Building Code Section 127. 0 , Construction Control. HOME OWNER'S EXEMPTION W = The code state that: "Any Home Owner 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 Home Owner engages a persons) for hire to do such work,, . . such Home Ow:. shall act as supervisor. " Many Home Owners who use this, exemption are unaware that they are assuming the responsibilities of a supervisor .!(see Appendix`,Q, Rules -and Regulations for licensing Construction. Supe=viso=s, Section. 2. 15) . This lack of aware::: often results in serious problems, particularly when the Home Owner hires unlicensed persons. In this case our Board cannot proceed against the :.nlicensed person as it'-would ,with licensed\S,upervisor., The Home 'Owner act: as supervisor is ultimately responsible. d. _o ensure that the Home Owner is .fully aware 'of his/her responsibilities, ma ommunities require, as part of the =permit application, that the Home Owner ertify that he/she understands the responsibilities of. a supervisor. On th. ast page of this issue is a form currently,\ used by several? towns. You may are to amend and adopt such a fo=/certification for use in your community. s T/lc• C111trtrr!ltr11'ealt/t of Afassachusetts :Mt! �,-_=j�� Department of ludustrial.4ccidcnts :1 1 ,' ! . office of1=0=1ga11ons •�� =ii. __�:� 600 ff axIii»gtu,r Street 4' Basturr.Muss. 02111 �• Workers' Compensation Insurance Affid:a-, �cnti n 011 am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capaciry •... _.�-•.—.._..___—.-,�.^.....��r--�-••-,�+-�.._ .. �-•sue---•..^--.•—..^_•----- I am an emplover providing workers' compensation for my employees working on this job. enntn•tny n•tmc- •tddrecc• pit%'• nitinne!!• incnr•tncc rn. n�iicv!! I am a sole proprietor. general contractor. or homeowner circle one) and have hired the contractors listed below who ha•. the Following workers' compensation polices: cnmrvinv n•ttne- ad�lrrc�� tin nhnnc+t• nnticv tt in�nr^ncr rn _ - •--•-- �. cmmnanc natnr� ;1d�lrrcc• rin•• nhnnc r3• incur•tnre cn nniieti•� T,— Attach additional sheet if necessary ^^ :: =.d/• •�• •' •••'-',�... �.�..r.__.��+.! Fadurc to secure cuycraec as required dcr tectton:5A of 1%1GL 152 can Icad to the imposition of enmtnai penalties of a line up to SI.SDU.UU andiur u n c cars' imprisonment:ts %%cll as civil penaltics in the form of a STOP NVORK ORDER and a fine of S100.00 a day against me. 1 understand that n copy of this starenictit mat be furn•arded to the Office of Investigations of the DIA for coverage verification. !do hereht'cerrih•mil he peril at pena ties of perjure•that the information prorided above is true and erect. Print name Phone -- L _�W • aa��.a�w.�. I ' official use only do not write in this area to be compicted by tiny or town official city or tmvns permitilicensc it r'tBuilding Department ` QLicensing Huard [. t scicetmen's Otrec t' check irimmediate respunse is required ❑ C-. ❑ttcalth Department �. phone N: nUthcr�� r E contact person: t �- �� J , - The Town of Barwtable • �,$ Department of Health Safety and Environmental Services Building Division 367 Main Sheet,Hyatmis MA 02601 Ralph C=en Office: 508-790-6227 r Building Commissic Fax: 508-790-6230 e For office use only Permit no. ' r t Date AFFIDAVIT; i ` HOME MWROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the "reconstructfon, alterations, renovation, repair, moderni=tion, conversion, improvement, removal, demolition, or construction of an additlon to any Pig owner occupied building containing ch reti��of buildf buildingnot mom than four dwelling units be done by registered contractors or structures which are adjacent certain exceptions, ong with o er irements Type of Work: ! RsL Cost Address of Wont Owner's Name Date of Permit Application: 1 hereby certify that: . Registration is not required for the following reasou(s): Work excluded by law Job under S1,00L Bn�' diagirot owner-occupied Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED` CONTRACTORS FOR APPLICABLE OGRAM OR G HOME iIARANTY FUND UNDER MGLOVEMENT WORK DO O 14ZA� ACCESS TO THE ARBITRATION SIGNED UNDER PENALTIES OF PERJURY I hereby appI for /apermit as,the a of �' ` tion No. Date Contract ame �� TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION is Maps Parcel of Permit# Health DivisionLZ Date Issued Conservation Division q IR163 W7- Awor/'ecoG 56 -34vI Application Fee U�?- s£3 -311'f t Tax Collector A Permit Fee Treasurer Planning Dept. Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address W,4 Po(10a PAS C- r &AE-� Village 070 1 1 or o Owner:54J- ICS " e_,C4 —Y Address TelephoneC1 g I� �6� 9( 9 � �L�- Permit Request Co N >—IILy C T70'7' (4'y,-34' ri (Eyi_ Af-j D 66kC44 A-ccogS S i�P5 cal N N y cle—Al ccjr LS c�1 9 1- (o o J E j" 3 `f 7 Na l , A Du Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation Construction Type Lot Size \ Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Famil ❑ Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes ❑No On Old King's Highway: ❑Yes ❑No Basement Type: ❑Full ClCrawi �' LJ Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing new Total Room Count(not including baths): existing �\ new First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil ❑Electric Other Central Air: ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑No Detached garage:❑existing ❑new size. Pool: existing ❑new size Barn:❑existing ❑new size Attached garage: ❑existing ❑new size Shed:❑e isting ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑ No If yes,site plan review# Current Use Proposed Use BUILDER INFORMATION Name _J_o+f- J 4APS is P Telephone Number Address �3 C- - -�q-�°� �fb� !� License# CS O(,7 6579 Home Improvement Contractor# 3 O Worker's Compensation# ALL.CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO _ &6kU)G IbL;�)p 1a d SIGNATURE DATE w FOR OFFICIAL USE ONLY a ---PERMIT NO. DATE ISSUED MAP/PARCEL NO. , ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION i FRAME INSULATION j FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL d GAS: ROUGH FINAL j 4 ` FINAL BUILDING i y E DATE CLOSED OUT ASSOCIATION PLAN NO. 1 i` The Commonwealth of Massachusetts _ :Department of Industrial Accidents office of/nsest/gations 600 Washington Street Boston,Mass. 02111 Workers' Compensation-Insurance Affidavit name: _ �aC P aN c5 lOcfltlOn• Cnln Ci C�Z� hone# I a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity [] I a�m+ an employer providing g workers' compensation for my employees working on this job � �k,''�ndXsv�yz€€-W �;�Fs'#z�•yrs.r,•2 s,�'•��.13a i'ax# ° ka �s' 7 i F �"Y.`�:. +. ,l�r r X 4(3u Fy�'`�'"roz'?tix: s,.�M � ���a,t'fi^41" ,5,x .+'�r-t'��'�t�t� 'a�.•a+s,� � «t �t �`s -3 7 'i rw t'3 - t.:.;lk4 "v i wl` ,x .t ii - com an name �� s ...ax•a.. .u`k 1F cr' -'`z'E yr.",;p 1� .h d.1Pyy t :> ;t l s �I "'A ✓i `r,"� xy.,ytt f+s.a`r{a�-��ti..fy'-o"t'ty. x r 4r-t sa'y, E �, -� 't 1.i t q, i �r-a ��as�, 1 ❑`t� o �-a f}.�S�a 'x' °'4 -t"'x €.N � •_ �' " � '.QhOne#Y.r's s �e �. ,.f s Sy4 Nts's'�s�C 3����.gx�,�,y���„�.�3.. PCI{�'s•of;t�i�;^�.k $t+.,�,,.t ^rf+4 � }�t r'L i s,y .,�� w � � r er'�+�'G b� '' ���h .F, E d�". * + N 7 .. 32#'z`i r r losurance co", a D v h ` Y QOhcy.:# t ;._ ,.., :,. _}., • .h-?t ._,— :,,., air I am'a ssole proprie oi, eneral contractor,or homeowner(circle one)and have hired the contractors listed below who have the following workers' compensation polices ,.'t'•C .� f* f �,. r�u� .r'1�'.,�A-''•��`t�.�t�s��xat�*� _.t:�r��f � x;".�,�r r+ i.i v.. e3 r sa � ��.s 5 4e - �t N � Y r � '��,.��aY t'e}wt�a.����°Y;� Sl`�}.�+•+,x- 1 t J- Y �{ nA .' �. -4. qF F'.=fix' y i j a ":a ,- "x.'9k'.'rss.ir}' b u r S a P<yr4kl . ,�, z �"` � h'�kq " ���t•�aa�1� r Fa r F "�'. Si i rf�ud� ,� � i �.I x �`k' � �r<+{��r��: CI��,F4a x in r � _,a,S,. - z, + .Tr 5 �` Y� ,. i y3-. „�. "�. � z�8 .y t•'r'tF � raa,. '`a Is t "��^`. '.�a'45n�rz�'pr�`` x���.s_5� €�»F i�x s,Yaa`.�i"=i�'.�}yac7t�s�+`x{lu Jv •FRS Cf s � sn, S hf# v� �r Rr` .1 s,li. �!«��'P ..`�M;r�erFR Y{'..,''h'Sy ;:'x`r' Fr'`..r2 }r a... r r; { `x.£' { .{ ,'d ',�iv ar 1 ✓`a x „€j�ssR`+,' r �' 3u5�°✓41"- .s- kFr e y r.:.t t s ^+ ✓ .. �''>r`Y "Ljr%I.s-qm � k h{ aG, ar r 5:._ xh d. * k" r �x.3 a, x x :o-ad' R �addrP�S9'`� ak4'icy� '�r,"�€1's?g„r air �� i^`"t•�s ,�eyF � { �"��T y �5 {zry `` st � � -xt V a � c wa F P }•ct..,a�n�` ,s,�a`. '"v`d'-tom r^�.a"a`���.��'*. �a• t•'t vf� v r Y a r€ QhOne�# } � �� s �� s.Z.�r"�"h'h-"�'""a..t P k�.`.'y+'� i"+.,',`� �.J t,�r�,'�,s•u +,£p "`��'i.-S s r�s N..�� i - {� „!� � fi 's.. �� : �`,y-r`�> � •'�3 t-r-r; ; i e +». ,x �FS� r a a .+G' � e pOIICV�# ?` ,r, �, r.'t`� ,.^r•.cSa;.. x+',w.w�e.,s.t..n�,rX:x v Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to 51,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of$100.00 a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certify under thepains andpenalties ofperjury that the information provided above is true and correct. Signature Date 6 Lo U9 Print name D Phone# official use only do not write in this area to be completed by city or town official city or town: permit/license# FlBuilding Department ❑Licensing Board check if immediate response is required ❑Selectmen's Office ❑Health Department contact person: phone#; nOther (revised 9/95 PIA) Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the"law", an employee is defined as every person in the service of another under any contract of hire, express or implied, oral or written. An employer is defined as an individual, partnership, association, corporation or other legal entity, or any two or 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 section 25 also states that every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally,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 in the workers' compensation affidavit completely, by checking the box that applies to your situation and supplying company names, address and phone numbers along with a certificate of insurance as all affidavits 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. City or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out.in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. The affidavits may be returned to the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,Ma. 02111 fax#: (617) 727-7749 phone#: (617) 727-4900 ext. 406 P�of1ME, ti Town of Barnstable Regulatory Services &UWST^BLFF ' Thomas F.Geller Director asass. 9`�ArEp;o.�A Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-403 8 Fax: 508-790-6230 Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, improvement,removal, demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions, along with other requirements. DC>Cr_ Type.of Work: &iL_ ( _z, S /—Y,-- C-r-7° Estimated Cost r�ScSD O , a D Address of Work: (o &V �� �P of cs s E1— C 6 I--Z) Owner's Name: �r�J�l�S -Q Po /1',40 Date of Application: -1 4 I hereby certify that: Registration is not required for the following reason(s): ❑Work excluded by law ❑JobJJnder$1,000 2 wilding not owner-occupied El 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: 6 L O W,') S r/ �O a Q D t Contractor Name Registration No. OR Date Owner's Name I RESIDENTIAL BUILDING PERMIT FEES APPLICATION FEE New Buildings,Additions $50.00 Alterations/Renovations $25.00 Building Permit Amendment $25.00 FEE VALUE WORKSBEET NEW LIVING SPACE square feet x$96/sq.foot= x.0031= plus from below(if applicable) ALTERATIONS/RENOVATIONS OF EXISTING SPACE square feet x$64/sq.foot= x.0031= plus from below(if applicable) GARAGES(attached&detached) square feet x$32/sq.ft.= x.0031= ACCESSORY STRUCTURE>120 sq.ft. >120 sf-500 sf $35.00 >500 sf-750 sf 50.00 >750 sf- 1000 sf 75.00 >1000 sf- 1500 sf 100.00 >1500 sf-Same as new building permit: square feet x$96/sq.foot= x.0031= STAND ALONE PERMITS Open Porch x$30.00= (number) Deck x$30.00= (number) Fireplace/chimney x$25.00= (number) Inground Swimming Pool $60.00 Above Ground Swimming Pool $25.00 Relocation/Moving $150.00 (plus above if applicable) n Permit Fee ��. APR-07-03 04:21PM' FROM-law office 781-662-4428 T-826 P.002/002 F-951 r E Town of Barnstable i Regulatory Services �• 9 'A Thomas V.Geller,Director f079. Building Division �lfD'AA � -rout perry, Building(:'omm4sloner Zoo Main S'zeer, Hysmii,MA.02601 Office; 508.862-4038 508-790-6230 Property Owner Must Complete arxd Sign This Section If Using A Builder as Ovmar of the subject pruperty hereby amhorize C2,i F/�'l -r�,�'c C�� •72 r4-�� �^ to acr on my bebLf, in all.matters relative to work aurhorized by this buzlciing permit application for (aci.dmss of job) %7 c- 'tci z zar -f 4 .,,.. ....�.. . .. Sigruiture of Owner date Print Name 0;raRM5:OWN2BL? .V1SSi4N ACORD�„ ,CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 03/28/2003 PRODUCER (508) 586-2973 ;, .,;;,., THIS CERTIFICATE 1S ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE McCormick & Sons Insurance Agency, Inc HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 800 West Main Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Avon MA 02322- INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A:COMMERCIAL GENERAL UNION CAPE MARINE CONTRACTING INSURERB:WORKERS COMP ASSIGNED RK P. 0. BOX 297 INSURER C: INSURER D: FORESTDALE MA 02644- 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 DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADD'L POLICY EFFECTIVE POLICY EXPIRATION LTR INSRD TYPE OF INSURANCE POLICY NUMBER=y >•�B,,.. DATE(MM/DDIYY) DATE(MM/DD/YY) LIMITS GENERAL LIABILITY t4; • / / / / EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES 000 PREMISES Ea occurrence $ CLAIMS MADE OCCUR CBJH50751 '09/01/2002 09/01/2003 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 1,000,000 ' POLICY JECOT LOC AUTOMOBILE LIABILITY / /. / / COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $ ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) $ HIRED AUTOS / / / / BODILY INJURY NON-OWNEDAUTOS (Per accident) $ PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO / / / / OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY / / / / EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ DEDUCTIBLE / / / / $ RETENTION $ $ WORKERS COMPENSATION AND sole proprietor 03/28/2003 03/28/2004 TORY LIMITS T EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 100,000 OFFICER/MEMBER EXCLUDED? to be issued / / / / E.L.DISEASE-EA EMPLOYEE$ 500,000 If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ 100,000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL "t TI 10 DAYS WRITTEN NOCE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE JAMES MITCHELL INSURER,ITS AGENTS OR REPRESENTATIVES. 664 POPPONNESSET RD A THORIZED REPRESENTAATTIjE� COTUIT MA - •-M& ACORD 25(2001/08) ©ACORD CORPORATION 1988 q_r INS025(0108).01 ELECTRONIC LASER FORMS,INC.-(800)327-0545 Page 1 of 2 »,. Board of Building Regulations and Standards / HOME IMPROVEMENT CONTRACTOR Registration: 130009 Expiration: 12/13/03 Type: Individual John Hanson John Hanson r 353 Carriageshop Rd. � East Falmouth,MA 02536 ✓fie �amvr�w-ruueall�c o�.i'T/laaaa�uvella .. BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number: CS 067659 Expires: 12/20/2003 Tr.no: 12346 a�f:...... . Restricted: 00 JOHN A HANSONr 353 CARRIAGE RD E FALMOUTH, MA 02536 Administrator se only or registration valid for un i return to' License if fo before the expiration date. Board of Building Regulations and Standards One Ashburton Place Rm 1301 Boston,Ma•02108 --- _. Nit ,• id..vitbnnt cinnatarP," r 00-35,000 cf enclosed space (MGL C.112 S.60L) 1A-Masonry only 1 G-1&2 Family Homes Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. DIG SAFE CALL CENTER: (888)344-7233 Bk 13494 Pg 124 #3506 01 —18-2001 02 : 08p • Massachusetts Department of Environmental Protection DEP File Numbe—. Bureau of Resource Protection - Wetlands SE3-3447 Provided by D_P WPA Form 5 - Order of Conditions Massachusetts Wetlands Protection Act M.G,L. C. 131, §40 01•TMFT0♦ TOWN A. General Information Ktsa Imp i639 ' When f Iling From: out forms on Barnstable the computer, Conservation Commission use only the tab key to This issuance if for(check one): move your cursor-do El Order of Conditions not use the return key. ❑ Amended Order of Conditions To: Applicant: Property Owner (if different from applicant): IL le Popponesset Bay Realty Trust Name Name 20 West Emerson Street . Mailing Address Mailing Address Melrose, MA 02176 City/Town State Zip Code City/Town State Zip Cade 1. Project Location: 664 Popponesset Road, Cotuit Street Address City/Town 006 016 ' Assessors Map/Plat Number Parcel/Lot Number 2. Property recorded at the Registry of Deeds for: Barnstable 11041 331 County Book Page Certificate(if registered land) 3. Dates: October 28, 1998 June 8, 1999 January 10, 2000 Date Notice of Intent Filed Date Public bearing Closed Date of Issuance 4. Final Approved Plans and Other Documents (attach additional plan references as needed): Revised Site Plan Novemberl4. �-`2000 Title ' Date 5. Final Plans and Documents Signed and Stamped by: Craig Short, PE Name _ 6. Total Fee: 110.50 (from Appendix B:Wetland Fee Transmittal Form) WPA For 5 d'a,�e 11 Rev OZ+00 Bk 13494 P9125 #3506 DEP File Number: Massachusetts Department of Environmental Protection - Bureau of Resource Protection - Wetlands WPA Form 5 — Order of Conditions ProvidedbyDEP Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 B. Findings Findings pursuant to the Massachusetts Wetlands Protection Act: Following the review of the above-referenced Notice of Intent and based on the information provided in this application and presented at the public hearing, this Commission finds that the areas in which work is proposed is significant to the following interests of the Wetlands Protection Act. Check all that apply: ❑ Public Water Supply [;� Cand Containing Shellfish [-Prevention of Pollution ❑ Private Water Supply ®fisheries ©--Protection of Wildlife Habitat ❑ Groundwater Supply [Storm Damage Prevention 2"O'Flood Control Furthermore, this Commission hereby finds the project, as proposed, is: (check one of the following boxes) Approved subject to: L✓1 the following conditions which are necessary, in accordance with the performance standards set forth in the wetlands regulations, to protect those interests checked above. This Commission orders that all work shall be performed in accordance with the Notice of Intent referenced above, the following General Conditions, and any other special conditions attached to this Order. To the.extent that the following conditions modify or differ from the plans, specifications, or other proposals submitted with the Notice of Intent, these conditions shall control. . Denied because: ❑ the proposed work cannot be conditioned to meet the performance standards set forth in the wetland regulations to protect those interests checked above. Therefore, work on this project may not go forward unless and until a new Notice of Intent is submitted which provides measures which are adequate to protect these interests, and a final Order of Conditions is issued. - ❑ the information submitted by the applicant is not sufficient to describe the site, the work, or the effect of the work on the interests identified in the Wetlands Protection Act. Therefore;work on this project may not go forward unless and until a revised Notice of Intent is submitted which provides sufficient information and includes measures which are adequate to protect the Act's interests, and a final Order of Conditions is issued. A description of the specific information which is lacking and why it is necessary is attached to this Order as per 310 CMR 10.05(6)(c). General Conditions (only applicable to approved projects) 1. Failure to comply with all conditions stated herein, and with all related statutes and other regulatory measures, shall be deemed cause to revoke or modify this Order. 2. The Order does not grant any property rights or any exclusive privileges; it does not authorize any injury to private property or invasion of private rights. 3. This Order does not relieve the permittee or any other person of the necessity of complying with all other applicable federal, state, or local statutes, ordinances, bylaws, or regulations. VrPA Fun 5 Page 2 0!7 Rev 02100 H k 13494 P g 126 #3506 DEP File Number: •��:: Massachusetts Department of Environmental Protection >: n Bureau of Resource Protection - Wetlands WPA► Form 5 — Order of Conditions Provided by DEP Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 B. Findings (cont.) 4. The work authorized hereunder shall be completed within three years from the date of this Order unless either of the following apply: a. the work is a maintenance dredging project as provided for in the Act; or b. the time for completion has been extended to a specified date more than three years, but less than five years, from the date of issuance. If this Order is intended to be valid for more than three years, the extension date and the special circumstances warranting the extended time period are set forth as a special condition in this Order. 5. This Order may be extended by the issuing authority for one or more periods of up to three years each upon,application to the issuing authority at least 30 days prior to the expiration date of the Order. 6. Any fill used in connection with this project shall be clean fill. Any fill shall contain no trash, refuse, rubbish, or debris, including but not limited to lumber, bricks, plaster, wire, lath, paper, cardboard, pipe, tires, ashes, refrigerators, motor vehicles, or parts of any of the foregoing. 7. This Order is not final until all administrative appeal periods from this Order have elapsed, or if such an appeal has been taken, until all proceedings before the Department have been completed. 8. No work shall be undertaken until the Order has become final and then has been recorded in the Registry of Deeds or the Land Court for the district in which the land is located,within the chain of title of the affected property-In the case of recorded land, the Final Order shall also be noted in the _ Registry's Grantor Index under the name of the owner of the land upon"which the proposed work is to be done. In the case of the registered land, the Final Order shall also be noted on the Land Court. Certificate of Title of the owner of the land upon which the proposed work is done. The recording information shall be submitted to this Conservation Commission on the form at the end of this Order, which form must be stamped by the Registry of Deeds, prior to the commencement of work. 9. A sian shall be displayed at the site not less then two square feet or more than three square feet in size bearing the words, "Massachusetts Department of Environmental Protection" [or, "MA DEP"] "File Number SE3-3447 10. Where the Department of Environmental Protection is requested to issue.a Superseding Order,the Conservation Commission shall be a party to all agency proceedings and hearings before DEP. 11. Upon completion of the work described herein, the applicant shall submit a Request for Certificate of Compliance (WPA Form 8A) to the Conservation Commission. 12. The work shall conform to the plans and special conditions referenced in this order. 13. Any chance to the plans identified in Condition,#12 above shall require the applicant to inquire of the Conservation Commission in writing whether the change is significant enough to require the filing of a new Notice of Intent. 14. The Agent or members of the Conservation Commission and the Department of Environmental Protection shall have the riaht to enter and inspect the area subject to this Order at reasonable hours to evaluate compliance with the conditions stated in this Order, and may require the submittal of any data deemed necessary by the Conservation Commission or Department for that evaluation. %VPA Fc.rn: Page 3 of 7 Re 02/00 ' 6k 13494 Pg 1 iL'•7 #3506 DEP File Number: Massachusetts Department of Environmental Protection h Bureau of Resource Protection - Wetlands _ WPA Form 5 — Order of Conditions ProvidedbyD Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 B. Findings (cont.) 15. This Order of Conditions shall apply to any successor in interest or successor in control of the property subject to this Order and to any contractor or other person performing work conditioned by this Order. 16. Prior to the start of work, and if the project involves work adjacent to a Bordering Vegetated Wetland, the boundary of the wetland in the vicinity of the proposed work area shall be marked by wooden stakes or flagging. Once in place,the wetland boundary markers shall be maintained until a Certificate of Compliance has been issued by the Conservation Commission. 17. All sedimentation barriers shall be maintained in good repair until all disturbed areas have been fully stabilized with vegetation or other means,At no time shall sediments be deposited-in a wetland or . water body. During construction, the applicant or his/her designee shall inspect the erosion controls on a daily basis and shall remove accumulated sediments as needed. The applicant shall immediately control any erosion problems that occur at the site and shall also immediately notify the Conservation Commission, which reserves the right to require additional erosion and/or damage prevention controls it may deem necessary. Sedimentation barriers shall serve as the limit of work unless another limit of work line has been approved by this Order. Special Conditions (use additional paper, if necessary): see attached Findings as to municipal bylaw or ordinance Furthermore, the Barnstable hereby finds (check one that applies): Conservation Commission ❑ that the proposed work cannot be conditioned to meet the standards set forth in a municipal ordinance or bylaw specifically: Name Municipal Ordinance or Bylaw Therefore, work on this project may not go forward unless and until a revised Notice of Intent is submitted which provides measures which are adequate to meet these standards, and a final Order of Conditions is issued. hat the following additional conditions are necessary to comply with a municipal ordinance or bylaw, specifically: Article 27 of Town Ordinances Name Municipal Ordinance or Bylaw The Commission orders that all work shall be performed in accordance with the said additional conditions and with the Notice of Intent referenced above. To the extent that the following conditions modify or differ from the plans, specifications, or other proposals submitted with the Notice of Intent, the conditions shall control. war.Fvm.5 pad,a c'i Re; CZ* Bk 134'94 Rg 1 c8 #3506 SE3-3447-Popponesset Bay Realty Trust Approved Plan=November 14,2000 Revised Site Plan by Craig Short,PE Special Conditions of Approval: 1. General Conditions 1-12 on the preceeding page are binding, and demand both your attention and compliance. 2. Within one month of receipt of this Order of Conditions and prior to the commencement of any work approved herein,General Condition number 8 (preceding page)shall be complied with. 3. The applicant shall pay for their legal advertisement as invoiced. 4. This permit is valid for 3 years from the date of issuance, unless extended at the request of the applicant. 5. The Natural Resources Dept. shall be notified at least 21 working days prior to the start of work at the site,to inspect the ares for shellfish. If deemed necessary by the Shellfish Constable, shellfish shall be removed from the work area to a suitable site and/or replanted at the locus following construction. The foregoing measures for shellfish protection shall ensue at the expense of the applicant. 6. The applicant shall obtain a building permit for the proposed pier from the Town Building Commissioner. 7. No creosote treated materials shall be used. 8. The proposed stairs shall be constructed a minimum of one foot above grade without solid risers. 9. Deck plank spacing shall be at least one inch. 10. No motorcraft shall be used or berthed at the pier. It shall serve non-motorized craft only. This condition shall continue over time. 11. No craft berthed at the pier shall be allowed to rest on the bottom at any low tide. 12. It is the responsibility of the applicant,the owner and/or successor(s) and the project contractors to ensure that all conditions of this Order are complied with. The applicant shall provide copies of the Order of Conditions and approved plans(and any approved revisions thereof)to project contractors prior to the start of work. 13. The Conservation Commission, its employees, and its agents shall have a right of entry to inspect for compliance with the provisions of this Order of Conditions. i Bk 13494 Pg 129 #3506 14. At the completion of work, or by the expiration of the present permit, the applicant shall request in writing a Certificate of Compliance for the work herein permitted. Where a project has been completed in accordance with plans stamped by a registered professional engineer, architect, landscape architect or land surveyor, a written statement by such a professional person certifying substantial compliance with the plans and setting forth what deviation, if any, exists with the record plans approved in the Order shall accompany the request for a Certificate of Compliance. Bk 13494 Pg130 #3506 • DEP File Number: Massachusetts Department of Environmental Protection Bureau of Resource Protection - Wetlands Y_ WPA Form 5 — Order of Conditions Provided byDEP y .Q: Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 B. Findings (cont.) Additional conditions relating to municipal ordinance or bylaw: see attached This Order is valid for three years, unless otherwise specified as a special condition pursuant to General Conditions#4, from the date of issuance. Date This Order must be signed by a majority of the Conservation Commission. The Order must be mailed by certified mail (return receipt requested) or hand delivered to the applicant.A copy also must be mailed or hand delivered at the same time to the appropriate Department of Environmental Protection Regional Office (see Appendix A) and the property owner(if different from applicant). Signatures: or c. L � LkN ' On Of C41 c),C30 Day Month and Year before me personally appeared yQ-A to me known to be the person described in and who executed the foregoing instrument and acknowledged that he/she executed the same as his/her free act and deed. Notary Public My Commission Expires ? : ` ` Cry 4 4 :& This Order is issued to the applicant as follows: ; u., ,• �{ ;c,F'�..a, r ❑ by hand delivery on { by certified mail, return receipt..,r@gu•�5ts� 1G�', `� January 10, 2000. .Date Date WPA Form 5 Page 5 of 7 Rev.07J00 8ARNSTASIE REGISTRY OF DEEM �� [ � a Assesi;or_s offioe (1st floor):• ' ,t o _. . ` ` 'THE To Assessor's .ma , and lot numb ......... ......>„` s Board of Health'(3rd floor):'', Q$� ��'� SEPTIC SYSTEM, a �" Sewage Permit number ................................:�..... .� ` ' INSTALLED IN,COMPLI �4TAXLE, Engineering Department (3rd floor) �l k �' WITH TITLE 5. 9, raea t639- House number ..... ......... .............�.(�.�.... .. t. �N�AIR®BllllirdEMIT/4L CODE _. APPLICATIONS PROCESSED 8:30-.-9:30 A.M., and 1:00-2:00:P,M. only TOWN REGULA710N,I TOWN. OF BARNSTABLE a 'RURDING INSPECTOR APPLICATION FOR PERMIT TO ..... .. TYPE 'OF CONSTRUCTION ........... ............ ................... ........ TO THE INSPECTOR OF BUILDINGS: " The undersigned hereby pplies fora `permit according to the following' information: Location .(��.. .. .cV Vim ................ a /.......... . .Proposed Use ..... .. ........:. ............ Zoning District .......... 4.....:......................Fire District .......... .................................. Name•of Owner �'e �a.....d ...... ..........Address ....`J...... .ld• �1.. r-4.tl �? 1j.F0 ,0..... .............���.......... .................. - Name of- Builder- ... �7:.. ........Address - � . . ..... ........ Name of Architect ..................0011 .........:. . ......:.. .......Address Number of Rooms .............. I................................:......Foundation .. ? .. •`... .� • '00 Exterior ... ............. ..,,rGt ...................................... k .........Roofing ....:. Floors .................... .....:.........................r::............................Interior +t. x ............. .. ..................................................... Heating .......... .. ...."` ...............:...Plumbing -- .........:......... Fireplace ............ ...............................................Approximate Cost A? .�..v. _..le.0.... 'Definitive Plan Approved by Planning Board' ___________ ____________-____._.19___'____ : Area 149..X.A6_6....:............. Diagram of Lot and Building with Dimensions = Fee ,d��^ . SUBJECT TO APPROVAL OF BOARD OF., HEALTH .3', _ µ' •+= OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Re ulations of the T= of Barnstable re -ardin th 9 g g e above construction. 'a �., Name .... ...... E f Co t ction Supervisor's License FORD, JOSEPH D. "' 2967f Enclose Deck - Permit,for , Sin le Famil Dwellin Location 'Lot #2, 664 Popponesset Road* r ....... ................... Cotuit Owner .......Joseph D. Ford........................................... Type of Construction ........Frame...........:............ F: ; .............'..:..... ........ ................ Plot ............................ Lot ............................. ; 47� t July 17,; 86 Permit Granted ........ .........1.9 Date o:Inspection .. ~....... .......1 q ' •E Date, Completed .........�..61.��...... 19 _5" a .. ..• - ` �. r � ,,, � • ' .: a '. �� � .. - 4 , Assessor's offioe (1st floor): O Q CF T N f TO Assessor's map and lot numb q��...............�.....`...........y'�`.�'P, rO�P�..���.: �`♦� Board of Health (3rd floor): ►g Sewage Permit number >; BAUSTABLE, . Engineering Department (3rd floor): / / 90o rb 9. YPY House number t0(o o, 3 . ............................................ .......................... CEO 4, APPLICATIONS PROCESSED 8:30-9:30 A.M. and 1:00•2:00 P.M. only TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO ..... .. �' ? / '• ......................... TYPE OF CONSTRUCTION ..........,�df..,.�..................................................................................................... ............�..." .........../ 19 - TO THE INSPECTOR OF BUILDINGS: The undersigned LL�,hereby,,applies for a permit according to the following information: Location .f<'7A.fi...... �% .. ?.5 ..f''� .. e /// ��� ....... O.T-�a.. ......... �...... . 11 ProposedUse ....: ............. .:....: A't a!�+'i :. .................................................................................. Zoning District ........................................................................Fire Dlistrict :. ........... I Name of Owner�de �" ... j..... :...... '��, �................Address .�� ?. ..?:d...;. �-.. . ........�r�':..... t!E+, � - r n v '� , Name of Builder-.1 L.vss �R...A.....!t .-...... � .............Addresss .. ................................................................................ Name of Architect ..................0 .!?.,.e...............................Address Number of Rooms .................... ..........................................Foundation .. -..! Exlerior ... +!► ,......f,., --........`....................................Roofing ............ ....................................... ............................... Floors .................... ..............................................................Interior ................. � i Heating .........,.,/,/,',..4, x ............... .....................................Plumbing ............. ` Or Fireplace ............./ .. -...................................................Approximate Cost .........4Q oev. &0 ..................................................... Definitive Plan Approved by Planning Board ________________________________19________ . Area .4... ... ................... 80 Diagram of Lot and Building with- Dimensions Fee ............................... SUBJECT TO APPROVAL OF BOARD OF HEALTH OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Tower of Barnstable regarding the above construction. Name ................. :... ......... ... ......... Constir,Iction Supervisor's License ........... FORD, JOSEPH D. A=006-016 i No 29671 Permit for ....Enclose Deck Single Familx dwelling................ Location .....Lot 4.24 664 Poppone.sset Road. Cotuit ............................................................................... Owner ............ . Ford . .............................. Type of Construction .Frame . .............................. .......................... ................................................. j Plot ............................ Lot ................................ Permit Gran'ed July 17, 19 86 Date of Inspection ....................................19 Date Completed ......................................19 C114WCC 7-V FE r .Asse` r's map- and lot number ........... .� QUM SYSTEM MUST 69 INOTALLED IN comPLIAN99 'J AR Sewage-Permit number ;.:� G .......................... � � �Aa�� �� ��'�'�� mv, cam X0 1 . WM t "Qyo�TxEV .to�� "I - TOWN OF BARNS LE t� Z BBHB-4TSDLE, i rt t .. t' '. K�a DUhLDING INSPECTOR Op,i639. \0 'EDiMPY a', f r APPLICATIONc FOR4 PERMIT TO ................... S?Q !•••••• �C`C ` ri �t/�C � N TYPE OF CONSTRUCTION `...... ....1.....••F• ttom.. �V TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: � �' sue.?..... .......C.® ....... .. ....... �s'- .................... Location �..D.. ...... r ..+... ••.'o •• ................ Proposed Use S%.. . . /9 /> /h.�t .................................................., .... Zoning District .... ..............................................Fire District .......,...,.......,.... Name of Owner ..... .:.. ��' ...........Address .�.. .... d"+ ".. ...3Q. Name of Builder le ....�� �� .................AddressC .. � �Naesd„ �!• ..1. ..!....,........ Name of Architect .rA ..... ...s.�.��".. ..Address .. / ,e .�..�.2......................... Number of Rooms ::... . .........................r..........................Foundation o..� .�.. ................................. . o Exterior .. . ✓.. ..:' `. 0 .E"".lr.�T. ...Roofing .1 � �"�t!�a ,t147*....................................... ,x Floors .. .............................. ......................Interior .. . ..... �i.. .a.......................................•..,..............,.,... j 'Ile Heating /.. .........................................................Plumbing ...... ....... /.................. �...................... � !Fireplace ..�................................:.........................................Approximate Cost .............. ..... Definitive Plan Approved by Planning Board, 19 Area ... w-76 S:......,...._.. Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Nam .. ......C.:..........I....... Ford, Joseph D. 18118 one story, No .................. Pe innitz--for ..................................... single farhily dwelling .................................................................... Location P.O.ppon.e.se.t.t...Road ad.................... Cotuit ................................................................. Owne-r. ..............Joseph.....D......F..o r......d........................frame Type-of Construction .......................................... .. ...............e-................................................................ Plot ............................ Lot ........��2.................... February 26 76 -.,Permit Granted .... ......... ........ .................19 A j Date of Inspection ... . ...... ...7.4...��1.19 Date Completed ... .. .. �................19 PERMIT',REFUSED ...................................... ......................... .19 ............................................................................... ................................................................................. rt ............................................................................... ............................................................................... Approved ............................ .................... '19 ........................................................ ............................................................................... TT ;' SSA / POP N; F6J DAT 16iv L®T- 7 i f LOT 3 10 i ! w3 Wt:T•vv ' L o r 2jh O , s � 58 ..®IS1:sox. '•�:: . r j' ' l�°WT6/Rr JO - T PG AD C-40'WfDg .PUBLiC) r _ Plot' Plan: Scle Im' v 30' Being Ipt., 2as shown on a I, hereby certify that Plan -Rt tl,ed "Cotuit the existing foundation ' Highground" _by 'Bates & location s ,•orlrect as Chelhian Engineers dated Shown. and does conform July 1926 and recorded in °F M with the- building setback Barnstable ;registry of deeds.; reouirements of the Town ! A. 0 of Barnstable. + s . . Fee 201 1976 Joseph D. Ford " Q y - 134 8tleen Road F'21STE'� i Yarmouthpor't, Mans. ; SUR14, Signed ti f 1 mom. F-ww+-t-,vws• .:uv:,a.a i.,,yy�Assessors ma p� .;.,,,-.?,�,..c.;^•• �-,„+.-� ,.:.. r , � �Y H 1....,,. ,�..�...-cp- .-u`v .�,,, „... � t�: F 7.,v..,�, ,ry ,�.� and:.lot (number ............................. � Sewage Permit number I- c, •pF THE TOE"-- ;7 ® V V l W 4 0 11 ' - J1J/Ste.'n STAB L' 8 BAHHSTODim LE. yo E0,9 �;� � C�3® � I NSL! E C T® Wll: , ] .•. F„ � - tag '' v �t• ��, � ' - r . t .(- C t /j A ."� l •�'r `t l i �A APPLICATION FOR PERMIT TO .... .. .. .... ... ... .. 1 TYPE OF:CONSTRUCTION ...................... ..................................... TO THE INSPECTOR ,OF BUILDINGS: The undersigned hereby applies for permit according'to the following information:.' J 1 �r Location �:..n l' r ' .� .t�. � � �`^�••�� f.� r�c'.: � ✓�`�'c`st '" �a?i� .... . Proposed Use ..?f;..�..J./..... .� ........................................... .......................................... 01 Zoning District �!? C�.. .. .... :... /1 - .............................. ........................ 'Fire -District (. L. Name of Owner .r.? . wry....� ' .......Address / , - ....................... Name of Builder: ........ Address .. ......... ......... Name of; Architect ...., ....... ........ .. - ess Addr d ..,/ Numberof .Rooms ............................. ....... .:........... ........Foundation . .... ......�..V.I..� -........................... , Exterior F•1 ... .. ..Roofing y'.... \. ✓�/.....3�+` . ..... ... ......... .... . ..: I Floors - � Q �`-' ...:..:.. .:..........: .: ...:.........:....Interior .. . J-4 Heating a... l'....... .. ...... .Plumbing .... ... .. .. Fireplace ':...^ .e....... ....:,.. ..... ..................... .....::...........Approximate Cost Definitive Plan Approved by 'Planning Board ---_P-----________-__._____--- _ - Area ...{�...................... �.............. Diagram' of Lot a I d'. Building with Dimensions Fee .. 1 . . .. ... SUBJECT TO APP�OVAL• OF, BOARD OF HEALTH - • I. hereby agree to"conform to all, the—Rules and Regulations,of the Town•of Barnstable regarding the.above construction. 46 , Name . .......... .... .. .... .................... Ford, Joseph D. A=6-16 18198 one story, No ................. Permit for .................................... single family dwelling ............................................................................... kopponesset Road Location ................................................................. COW it ............................................................................... Owner Joseph D. Ford ................................................................. Type of Construction ......... ........................ ................................................................................ Plot ............................ Lot .........#....2 ................... FeVr,uary 26 .. ..... 76 Permit Granted ........... 19 Date of Inspection ...... .............19 Date Completed ........... .............19 PERMIT REFUS:D ........................... ............L.... .......... ..................................... .. .... .... .. ...... .... ............ .... . .......... .......... ..... ......... .... ........ . .............................................. ....... .. ....... ........ .................................................. Approved ................................................ 19 ................................................................................ ................... ........................................................... 1 �`• Ir I CERTIFY THAT THIS PLAN CONFORMS TO THE,1976 PULES AND REGULATIONS OF THE REGISTERS OF DEEDS, 412 DATE PMftS=NAL ENGINEER HO STRING SHOESTRING BAY BAY 2 N TIDAL UCU N EBB L rLUDD SCALE i 125 000 . • . -� - _ ______---- --- ��.� °• � LOCUS MAP :- -) l ,F -m.. . -Ld6D zoNE Ali o Y• (ELEV. 11 NGVD) D (ELEV. 12.25 MLW) 12 14 16 N/F .L !8 KATNERINE §PATH 653 POPONESSETT - 2 COTUIT, MA 02635 Z 6 20 fo /���� I=XISTING DAM 0 top br FbUNbAt1dN v/ t=Lt VATION .12 It 23.1 (HLW) Ln / -a r ul � } p R) r' 16/ AM 6/15 — 150' S-01-30 W. GEORGE C E WIN G S 1 ELAINE SWING 372 HATcHVILLE ROAD. POPONESSETT ROAD EAST FALMOUTH, MA 02563 N/F AM 6/22 PAUL J. WGHT 1'L e o 4� tILIVE. J. KNIGHT Won POPONE§SE7t b 1b 20 •40 10 60 ' COTUIT, MA 02635 ' CIVIL, ,I ww scALt AL PLAN ACWWANYING ktit t1N tr - PUPONLSSLTT MY REALITY' TRUST Wri-14. I'I_Am i\Er). 9 ! a3 _ - tIi WILD, LiCERM ARD HAIt1tAIN A Pitk roams lr� 1N §HOESTKING I Y f♦AkNsWU UOTY, Wt. CPAIG P, SHORT, P.E. II bnx io44 stknti K4Nis, MA ` bATE b4/25/0i SOA-399-831i ,- SHEET L OF 3 i r I CERTIFY THAT THIS PLAN CONFORMS `'"` TO THE, 076 RULES AND REGULATIONS t' OF THE REGISTERS OF DEEDS, h=r- DATE PR FESSIONAL ENGINEER fFE ay 01-04, 91_10 _" . EL. 14.83 _ _L= 2x10's 16'o.c 3x10 2x8 4x4 '-3• . =' PLAN VIEW j— 0 2 d 8 I6 _ SCALE 1 —8' = J 4'-0' MIN. - — . 8'-?• _ 20 4 6 4'-6 � 4 6•.. EL. 14.83 .... .l8 'v / 1 16. . 14 1.. 1..12. l0'-0' l0'-0` 9'-l0 l/4' l j l6'o.c. l0 ....... .... .... ........ ........ .. l2 6 r JJ EL 5.5 MLW .... ..... .... ............ .... ........ .......... r 4 3xlU .. ��2ic8 . . .... .diva ......... 6. .. ... ............ .... ........ ........ .. ....L j�........... .... .... .. . .... ........ .... ....?. ........... ....1.1....... .... ......... . .. .. ... .i- 2 ... .... ..... ..... PROME 11 11 n SCALE 1`=8' 0 2 4 8 l6 = ' sHonr r= { CIVIL.. i AL PLAN ACCONI'ANYING PETITION OF POPONESSETT BAY REALITY TRUST _ TO BUILD, LICENSE AND HAINUIN A PIER �g IN Sil[IESTRING BAY WEN PLAN NO, c{ 103 BAItIlstA&E C[IMTY► HASS. 1 } CR A IG R SNORT, PE, Approved by Deparrmelat of tWwimental Protection P. o. BOX 044 SMTN DENNIS, MA 02660 508-398-8311 DATE 04%25/Ot SHEET 2 [IF 1 I •a - yrr r?l I CERTIFY THAT THIS PLAN CONFORMS TO THE J916 RULES AND REGULATIONS OF THE REGISTERS OF DEEDS, �+ DATE PR9FhSIONAL ENGINEER 4/-0i x6 TOP: RAIL 5/4 X 6 DECKING Ti W/3/4' SPACING o x4 POST MID-SPAN.. :. 3xI0 JOIST (E = 3) DECK EL. 2x8 JOIST EACH 1/2` DIA, GALV, BOLT, SIDE OF PILE NUT & WASHERS i 3/8 GALV. BOLTS • MSL EL 1.25 = MLW EL 0.0 2x4 CROSS BRACE (1929 DATUMS 4x4 PILE/POST (PO- Coh COMM) EXISTIN PILE EMBEDMENT o - - - TO E L R� USAL s:= r„ to'.`MINIMUM TYPICAL PIER BENT (10' O.C,) ' CROSS SECTION `= THIS PLAN PROPOSES TO ATTACH A DOCK TO THE REPLACEMENT STAIRWAY BEING PERMITTED TO REPLACE AN EXISTING GROUND LEVEL STAIRWAY. r` ALL LUMBER AND PILES ARE TO BE TREATED WITH 'WOLMAN SALTS` ALL STRUCTURES ARE TO BE CONSTRUCTED WITH HANDRAILS AND IN COMPLIANCE Y WITH ALL STATE AND LOCAL BUILDING CODE REQUIREMENTS, STRUCTURAL SPIKES `< ARE TO BE 20d, ALL BOLTS, NUTS, WASHERS; SPIKES AND HARDWARE ARE TO BE HOT DIPPED GALVANIZED. ' `' ► '�F \"��• ..,. A, THERE !C1RA THERE IS TO BE 3/41 SPACING BETWEEN THE DECK BOARDS. :��v '� o I4 THE DECK OF THE DOCKS TO BE 3' ABOVE MEAN HIGH WATER. Worg THE DOCK IS TO HAVE TWO STAIRWAYS, ONE NORTH AND ONE SOUTI '_ r == CAVIL. LOCATED ABOVE THE MEAN HIGH WATER MARK. =' e I110.27403IST :. PLAN ACCOMPANYING PETITION OF POPONESSETT BAY REALITY TRUST TO 9UILD, LICENSE AND MAINTAIN A PIER IN SHOESTRING BAY ®: zm ; ! BARNSTABLE COIMTY, MASS. L��E S�' '-"V,H NU. 9103 CRAIG R, SHORT, P,E, Approved bii Depaomen5l of to ttxmhW Pf**n P. O. BOX 1o44 ba�` I R 2001 SOUTH bENNIS, HA 02660 DATE 04/25/01 508-398-8311 SHEET 3 OF 3 t