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0049 PUTNAM AVENUE
�� �%� � j J I I N i j 7 6d APPROVED6/-6,z �i TOWN OF BARNSTABLE f n GAS C�'WIRING PLUMBING ❑ BUILDING tyz �f„ BV I LSD I��_. 7E I d, PARCEL ID 040 600 194 �� GEOB:ASE ,ID ADDRESS 59 PUTNAM -AVENUE PHONE COTCIIT < ZIP' I LOT C ... B14OCK � €9T SIZE DBA ' DEVELOPMENT DISTRICT PERMIT e) 4786.17 DESCRIPTION NEB ..;4 BDI.M. SIN FAM/REMOVE KITCHtV\ �`�IST Ajj PERMIT TYPI Y $UILD TITLE . NEW RE IDENTIAIo 'jepaitk enteof'Healt4; Safety CONTRACTORS ROBERT J COOK and Environmental Services:. ARCHITECTS: ._ w. IME u TOTAL FEES: .'m l ,978".8 roi CyNtiJC-UC- -T_ E =CO7ry ? ,>;>-_.. 4,;$2 8, ra ,.0. 0 -T. A. .B , A+: 101 ��I LE FAM HOME D . CkIEI� 1 PRIVATE l��t,m �IT r�' ,.r BUILDIN IS10kr1ollBY i. r ! 4 1 `"LE I S S U 08/0ti3r23vnv EXPesRAI%ON DATE > THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET,ALLEY OR SIDEWALK OR ANY PART THEREOF, EITHER TEMPORARILY OR PERMANENTLY.EN-, CROACHMENTS ON PUBLIC PROPERTY,NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE,MUST BE APPROVED BY THE JURISDICTION.STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED FROMTHE DEPARTMENT OF PUBLIC WORKS.THE ISSUANCE OFTHIS. PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. . MINIMUM OF FOUR CALL INSPECTIONS REQUIRED FOR ALL CONSTRUCTION WORK: APPROVED PLANS MUST BE RETAINED ON JOB AND WHERE APPLICABLE, SEPARATE 1.FOUNDATIONS OR FOOTINGS THIS CARD KEPT POSTED UNTIL FINAL INSPECTION PERMITS ARE REQUIRED FOR ' 2.PRIOR TO COVERING STRUCTURAL MEMBERS HAS BEEN MADE.WHERE A CERTIFICATE OF OCCU- (READY TO LATH). PANCY IS REQUIRED,SUCH BUILDING SHALL NOT BE ELECTRICAL,PLUMBING AND MECH- 3.INSULATION. OCCUPIED UNTIL FINAL INSPECTION HAS BEEN MADE: `ANICAL:,INSTALLATIONS. 4.FINAL INSPECTION BEFORE OCCUPANCY. VISIBLEPOST THIS CARD SO IT IS BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS = I '"'rV 3 1 CHE NSPECTIOWAPPROVALS ENGINEERING DEPARTMENT p 0;s o� 2,,LL BOARD OF HEALTH �I ox,4 OTHER: SITE PLAN REVIEW,APPROVAL WORK SHALUNOT PROCEED UNTIL PERMIT WILL BECOME NULL AND VOID IF CON- INSPECTIONS INDICATED ON THIS THE INSPECTOR HAS APPROVED THE 'STRUCTION WORK IS NOT STARTED WITHIN SIX CARD CAN BE ARRANGED FOR BY. VARIOUS STAGES OF CONSTRUC MONTHS OF DATE THE PERMIT IS ISSUED AS TELEPHONE OR WRITTEN NOTIFICA- TION. NOTED ABOVE. TION. BUILDIN G PERMIT �', Assessor's map and lot number ........ X.. . _I,.,.�:,.. Sewage Permit number�h-0.���� "�`� 16�1�Ti4LL���gg0+�CM MUS'�` ;,�v,. o� .ry 9� ` - ARISTAD 1 ����Ie���'r .:H LE i House number .......:......_.........:.......::. ' ... .................' E 1 WITH TITLE 5 'ob Mb3v NMENTAL CODE R ' TOWN OF 'BARNS�TARtETlO°=' - BUILDI INSPECTOR APPLICATION FOR PERMIT TO ... . ..... ��..,, .....A. �!. u TYPEOF CONSTRUCTION ....:k .. . .. c'............................:..:................................:.........................:..... F .. . ...............19 7 � -TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies f r a permit according toLthe following information: Location ...?\.. .i�/��4.Vt.&.. �..1.�:L.,.... 1`,1�:,1.�.�.:�: .:.............:.......................... ProposedUse . ...................................................................................................................................... Zoning District ...................................... Fire District ...... �.9.::J: ........................................ Name of Owner :.1 .,. ... � ,. x.......Address �s. t� � Gv�,. .......... Name of Builder" ... . = .�. ..... .��, ...Address ........ ........ �,G��: . ., N�.`�`✓.... .r 11z�inn Name of Architect ............ 1.4..............................:.Address ..................... ............... .......... Number of RPM Foundation ,. '' •i��' - ; `d ....CG-ek-o_--r-le-A �Exterior .l.. .... .pC-�: ...........:...............................................Roofing ....�.'�.. ... � ':�................................................... FloorsInterior ............:.....................................:..............:........................................................:. Heating ..._.. .... Plumbing "Y Fireplace ........ ..................................... ......:......Approximate Cost .........'i.... ..:... .� . ........... Definitive Plan Approved by Planning Board --------------------------------19________. Area ......:................................... Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH T-1 OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the own of �n ab regarding`the 'ove construction. o Name ...... .. .,...F.. .... . ... .... ......... ROPES, EDWARD 24249 . REPAIR GARAGE No .................. Permit for .................................... Accessory; to Dwelling Locar, Pdtnam Avenue Cotuit I. ......................................................................I.......... Owner ...............................Edward Ropes............................ Frame -4N Type of Cons'tru' ction .........................:................. 1.0............ ..................................................... t. Plot ............................. Lot .................................. Permit Granted ....q:91Y... 2 Date of Inspection ........................... Date Completed .......... ..19' d eo� r T /9 Ufa Assessor's map and lot number �?..... . v.. a ......... FteeT o 0 Sewage Permit number•r�l-�:s3.?�s..•.--�..,....,1.�. .:...... Z 133 3TABLE. i House number ........................................................... ...:....... rasa 039. �90 TOWN OF BARNSTABLE BUIL D" un INSPECTOR APPLICATION FOR PERMIT TO ...... ... .. L} TYPE OF CONSTRUCTION .....�-,0• C.S... .................... ......... ..::................ . ...... . ......... ......... .. ...........�lf.. µ,. '................19 . TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies f r a permit according to the following information: Locationf.'.�..L` 'F,.�IL. ..... . .. � ,. .. Iti. .!..? . .... ..... .. .............. .. ... .............. ProposedUse .......(��� . �t, .�jy, [e .f . ......... ................ .. .............:. ... .... ........ ..... ............................... Zoning District ..... .... ........................Fire District ......b.�. .4.k a _ 'fir - Name of Owner Cr a.R�..;rx ::.l� 5!-°.! `?. .``r....:..Address ► : :.�,�. ..� k. �: ............: Name of Builder' �-,L. a Address Name of Architect .............fi\1../.... .................... .......,Address :...... ......... ......... ..:............................................. Number of R•oms ttt Foundation ` . . C� Exterior .3 A. r. . r�. .............:...........................:......:..........Roofing ... .� 1 ................................................... . cE� Floors { • • •tea :.. .`Y.............................................. ..Interior ........ ..... .:...... ... . .. ................................ la Heating .........0.I ........................................................Plumbing .................................................................................. Fireplace f"SSi _ .................................... ....................Approximate Cost ... :.�r ...�3 ,........ ..�.. ...... ..........:. j G Definitive Plan Approved by Planning Board ---------------- ----------------19_______. Area> .... Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH t � ! 1 •4 � l —f OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS' - I hereby agree to conform to all the Rules and Regulations of the Town of Bdrnsfable regarding the dbove construction. Name .. S:� ............ / ROPES, EDWARD 24249 Repair Garage No ................. Permit for .................................... Accessory to Dwelling ............................................................................... Location Q Putnam Avenue Cotuit ............................................................................... Owner Edward Ropes ................................................................. Type of Construction Frame ................................................................................ Plot ............................ Lot ................................ _ X� July 29, 82 Permit Granted ........................................19 Date of Inspection ....................................19 Date Completed ......................................19 0 �- • ' � � ( M•Ri6f 1'Nto'.Wfi1.t`.-a-+—•r - -' _ — 1. �1 - 1 rfa�....._...: . _.Blear EnMTtON - --AYf0.ttLv/KrLN � - � >srr-.ar•v�[¢�N.....:... :._ .,._.—�� r . t j I ..1-na.tmrs�we♦.p. - - ' [[[ 'E Dcsyc]Da��r- �.soal ."-�fll N♦64D ] •e 191ar.en..: mWe in Omit ns i �• ' '� m�.faa�'r'r. f'I P' b amr.rT - ZAP""w" mw tic5ort tour. . . ..... ' ....Fc1UliMTIDN PUI:1" GC<kISR�07:I f�f+_+_uY♦yYb� . 1 •.r N:♦n:n.ry ei.nr ene r.forrrr er'DC D.1re rot rn onry.Arry O]Mr are M lrry PrOMbr `s I. � 1— .___-- .uu:• _ ....ovm.r: Ai /afa i A M MALE - NEW PAIN NX _ � r EKyr Er•�/ LaWI I '_— JC.1 .. -•—. / 1 — �[ - I�1 '�../ Jl \k��'lt lip jr fn(%l r\C .' - u TD t I /-AFrt,e�a axrvj'X3 l,rnilcn/ iX•y, �... ,'� h A' t - - w M -1-7"I- - Dk.a,a-, r NE D _ - J C -... ... w G ' —E? ,r.,,,b -> .,,,.t��-c�.i� _ r r •,cr .^.. F l� _ wi T r ItIn. 11 n� - a gag Pr,nv _ rl(AMt lie' '"/V•SCnC' �i r .. - PT. (141�iVl s.'zc. rl r.('.. yrryfl)/G Nb N MA,CN n C ;. r L IA-7_LiLIL w r Avg' n B Pr Lt o6th- LAv a c,_ c ZA 13 eA,./J�netg .V .... -uw_1 � TIIII �•� � � vx; � � �---,I LIL y W II - LnJL^1HJ cX ow I Un4F I Far u�au o n0. NFLJ - - sr"oat I Au rro `\ - d At ?�z �•.' 6a3s L --- ��,� Y7GpP7 W5 .3 F• - 'F- !- "r. IS- "J_ 5:�..�_ Y'N/bN r _ _.—._.8�� _-'-"-" -- 4 35�.9'V�- � ,'!(4.P- "f TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map YO Parcel O 00 1 ,- Permit# SEPTIC Sy STEM a Healthbivision ;NSTALLED IN COIPWPL i'"' Conservation Division EI�� VVYITH TITLE q Fee �� IRONri�jFINTA� h$v 3 y o 'f/zzl4 s Tax Collector Y f, Treasurer a. Z k - Planning Dept., Date Definitive la, tpved by Planning Board Historic-OKH Preservation/Hyannis - Project Street Address Village0-m-u I (foC&rev, v s'. ra H N I K�«e- Owner Address Telephone O q Y Permit Request k6mobi5t 'r -5 Q S 0 6wjALL 2 5° rV LC-C' ' W i( o mile '.,v iA m4 6 TR i'"zz�q IU �� ; - Square feet: 1 st floor:existing prol.�posed 2nd flo r: existing proposed is Total new-- —�k6l(/ �'Jd I stimated Project Cost C) Qrb Zoning District Flood Plain Groundwater Overlay .. Construction Type vu J o Lot Size j , 5 -� A" 4 Grandfathered: ❑Yes Wo If yes,attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure I J66 Historic House: Ves ❑No On Old King's Highway: ❑Yes XNo Basement Type: ❑Full Pkrawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) - Basement Unfinished Area(sq.ft) Number of Baths: Full: existing 3 new / Half:existing new Number of Bedrooms: existing new 0 Total Room Count(not including baths):existing 10 new 6 First Floor Room Count Heat Type and Fuel: Gas ❑Oil ❑ Electric ❑Other Central Air: ❑Yes Ad"No Fireplaces: Existing _ New Existing wood/coal stove: ❑Yes XNo Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:)Q existing ❑new size Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes No If yes,site plan review# 'Current Use ���IP F d!� A-CivZA-16 Proposed Use l BUILDER INFORMATION Name�O�'VI�� ��5cel Telephone Number 05_ Address Il^ /466 t b 1c License# 9 S& 3 Home Improvement Contractor# /0 Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO �R� ,fA-6 � + SIGNATURE 04S DATE ? ' o FOR OFFICIAL USE ONLY -. .. PERMIT NO. ' DATE ISSUED MAP/PARCEL NO. ADDRESS R VILLAGE. y OWNER DATE OF INSPECTIO;III: FOUNDATION FRAME INSULATION °� � U fI ' , r FIREPLACE' -' ELECTRICAL: ROUGH FINAL, PLUMBING: ROUGH FINAL GAS: ROUGH FINAL - �{ -'FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. ` TOWN OF BARNSTABLE BUILDING'PERMIT.APPLICATION' Map <3 Parcel (26/</R. 00/ F1� r Permit# z Health Division - Z Z I ..5� � Date Issued � +. � .�✓` .Conservation Division CA L Fee 71 , 8 0 U Tax Collector % T SEPTIC SYSTEM MUST BE reasurer - " <, INSTALLED IN COMPLIANCE . Planning Dept. ,• , S • }` ENVIRONMENTAL Date Definitive Plan Approved by Planning Board . CODE AND : TOWN REGULATIONS Historic-'OKH Preservation/Hyannis i Project Street Address lv. Villagee�'i'V F { Owner J f ;j t� ,V OU lt5� #' Address Y 094L u i f °v:crb. ✓ 01 o N ,Telephone ° Permit Request C A0 oojv �v:�� a�- ^� X� � q Square feet: 1 st floor: existing • " proposed 2nd floor:existing proposed Total new Estimated Project Cost 23 � Zoning District Flood Plain Groundwater Overlay " Construction Type Lot Size Grandfathered: ❑Yes ❑No� If yes,attach supporting documentation. Dwelling Type: Single Family ❑ .;Two Family ❑ Multi-Family(#units) Age of Existing Structure . Historic House:yYes ❑ 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 ,4 new rt ' Total'Room Count(not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil O Electric ❑Other - Central Air: ❑Yes .❑No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑No 'Detached garage:❑existing ❑new size Poo isting U new size g.X 3 Barn:❑existing ❑new size. ''Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Reco'rded❑ Commercial ❑Yes ❑No If yes,site plan review* Current Use Proposed Use BUILDER INFORMATION Name_ � /'/Om/f.S Telephone Number Address �:3 L K l�D1 C/ 6A License# Home Improvement Contractor# � Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTI%FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE Grp `� DATE _ '�"2-!� -- t= FOR OFFICIAL USE ONLY PERMIT,NO. waT,l - 4. DATE ISSUED MAP/PARCEL NO. ADDRESS :` — VILLAGE OWNER W � • r,' ...} .' ? � • ` r ". :Y • _ 1 ,r, '' + • '. > DATE OF INSPECTION: FOUNDATION ��--e. " .� -L�• i 7 r`f _ ; i f { -FRAME INSULATION r FIREPLACE ELECTRICAL: ROUGH FINAL { PLUMBING: ROUGH FINAL h��y f GAS: ROUGH- FINAL ` i � yip � r -+ -, r• J '- l , • 4 �. S A . - . FINAL BUILDING co DATE CLOSED OUT - s 10 ASSOCIATION PLAN NO. _ im n TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map �C, Parcel Permit# Llq(v Health Division r Date Issued, Conservation Division m < jTc;�710� Feef3,� Tax Collector =4 ;•F: - 3",1 TreasurerT_ - INSTALLED IN C0-jPL1AiNX: WITH TITLE 5 Planning Dept. ENVIRONMENTAL CODE AND Date Definitive Plan Approved by Planning Board TOWN REGULATIONS Historic-OKH Preservation/Hyannis a ' Project Street Address Village Owner aftv►riC5 Address y 0* 09 C C7, O�j(Vl C I Lam, y Telephone p Permit RequestNS�g l C- y J C�uC���e �oy►v0,47i0�. EPC,��� C�1rrs, R I Z c��A+g� �A-c-r fopF tN b i� ti z ,�cev q E S'/DING Square feet: 1st floor: existing 00 proposed 2nd floor: existing 3o0 proposed Total new Valuation UZ:� Zoning District Flood Plain Groundwater Overlay Construction Type W©Db fRAn 6- Lot Size 1 . 13 ACRE Grandfatliered: ❑Yes ❑ No If yes, attach supporting documentation. I Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Agb of Existing Structure 1700 ? Historic House: .Yes ❑No On Old King's Highway: ❑Yes VNo Basement Type: ❑Full ACrawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) ` ® Basement Unfinished Area(sq.ft) 34 f Number of Baths: Full: existing new Half:existing new Number of Bedrooms: existing new Total Room Count(not including baths): existing new (5 First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil ❑ Electric Xother 110A) Central Air: ❑Yes *0 Fireplaces: Existing _� New Existing wood/coal stove: ❑Yes XNo Detached garage:❑existing ❑new size Pool:Xexisting ❑new size Barnp(existing ❑new size Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes >, No If yes,site plan review# Current Use ����' Proposed Use L_ v ACs BUILDER INFORMATION ' / t— Name / Ode Telephone Number `7 — 1� c� Address 3 R L�*8, o(e r License# L 7 Home Improvement Contractor# Worker's Compensation ALL CONSTRUCTION D I RESULTING FROM THIS PROJECT WILL BETAKEN TO / d bUMP5� SIGNATURE DATE r FOR OFFICIAL USE ONLY PERMIT NO. t " y DATE ISSUED - r MAP/PARCEL NO. . t r � ADDRESS VILLAGE OWNER' DATE OF INSPECTION , FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL • s PLUMBING: ROUGH FINAL GAS: ROUGH--z FINAL. - FINAL BUILDING 7 � m DATE CLOSED OUT i ASSOCIATION PLAN NO. y t f 1+ N �i RM q .. ..... ................_....__....._....__.___ - + 508.428.619' rgns in om •.0 ao9r '• In i p V r..u....•r o.•w....e u�o... ..C.........ine u a.wi.<.no...r.Dray,wq•o.n...0.....raq y.a. '� �I �C i T e 4 I .pa II EIEVnT10N C - ...._._.._............. h Afir - 4 7ren �.. j ::i {. t I � 1 Ill V r! - -- t I i nnu.!n•.y 91anr. Iay9Y.•9y oc.o..r•wr.n•Y..a IK ony.wny orn«Y.e 1•..rl•.ly yraY m. Lo F �.� x y Pow r k t.' Town of Barnstable = *Permit# �1. Ecpires 6 ni ntlis onr issue ate Regulatory Services gee • r + HARNSTAHLE, MASS. Thomas F. Geiler,Director y� i639 1�$ �lfD MP't A Building Division Tom Perry, CBO,.Building Commissioner ,200 Main Street,Hyannis,MA 02601 www,town.b ams table.ma.us Office: 508-.862-4038 Fax:508=790-6230 EXPRESS PERMIT APPLICATION RESIDENTIAL ONLY 2 Not Valid without Red X-Press Imprint Map/parcel Number Property Address �.-C Residential Value of Work /0169,1`4 0 Minimum fee-of$25.00 for work under$6000.00. Owner's Name&Address —5t V-4 Det N"i C V S e✓ O A s ' e4 .' - 1 eo rl S i r u c- t 01%—}. Telephone Number �U�,�lav'--O`f,S-dam Contractor's Name - f' - Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if-applicable) 18 01 a .,. ' , RAM [ Workman's Compensation Insurance' . Check one: .1� I am a sole proprietor ❑ I am the Homeowner TOWOF BARNSTABL I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# t0 r Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) Re-roof(stripping old shingles) All construction debris will be toS ' ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side #of doors ❑ Replacement Windows/doors/sliders:U-Value (maximum'.44)#of windows *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: roperty-Owner must sign Property Owner Letter of Permission. A copy of the home Improvement Contractors License& Construction Supervisors License is required SIGNATURE: Q:\WPFILES\FORMS\building permit formS\EXPRESS.doc The Commonwealth of Massachusetts Department oflndustrialAccidents Office of Investigations 1500 Washington Street �� Boston, MA 02111 2�=s� wmv:niass.gov/din Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant.Information Please Print Legibly, Name (Business/Organization/Individual): d�Q�S `✓ '0tUSit Address: Ci-7 CM of d r t City/State/Zip: LA• BMA IlS t a Phone #:sd(T Yd(f _6 Are you an employer? Check the appropriate box: Type of project(required): 1. with employer I am a[� 4. I am a general contractor and I �— 6. ❑New-construction employees (full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet.. 7, ❑ Remodeling ship and have no employees These sub-contractors have g• Demolition workingfor me in an capacity. employees and have workers' Y P Y• 9. ❑ Building addition [No workers' comp. insurance comp.insurance.$ required.] 5. We are a corporation and its 10.❑ Electrical repairs or additions 3•❑ I am a homeowner doing all work officers have exercised their 11.E]Plumbing repairs or additions myself o workers' com right of exemption per MGL y [N p. 12.E:] Roof repairs insurance required.] t C. 152, §1(4),and we have no - employees. [No workers' 13:0 Other comp.insurance required.] "Any applicant that checks box NJ 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. tContraclors 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: ' f4.N , P I q Policy# or Self-ins.Lic.#: (D NU�. � Expiration Date t Q 0 0 . ,lob Site Address: LM PV lrj 4" -�-e 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 MOL 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 le DIA for insurance coverage verification. I do hereby c fy under he ins and penalties of perjury that the information provided laove i trite and correct. Si natur /� Date: ® 7 10 Phone#• ��09 6'-IS(? Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License# Issuing Authority.(circle one): 1.Board of Health 2.Building Department 3. City/Town Clerk 4. Electrical Inspector S. Plumbing Inspector 6. Other Information and. Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as "an individual,partnership, association, corporation or other legal entity, or any two or more g engaged g ) P of the foregoing a ed in a joint enterprise, and including the legal representatives of a deceased employer, or the o receiver or trustee of an individual, partnership, association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair.work on such dwelling house or on the grounds or building appurtenant thereto shall,not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7) states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary,supply sub-contractors)name(s), address(es) and phone number(s)along with their certificate(s) of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP) with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the pen-nit 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 insuredcompanies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact,you regarding the applicant; Please be sure to fill in the permit/license number which will.be used as a.reference number. In addition, an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information (if necessary)and under"Job Site Address" the applicant should write"all locations in (city or town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit'is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.)said_person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASS.AFE Fax # 617427-7749 Revised 4-24-07 www.inass.gov/dia i �IHE r � Town of Barnstable °^ Regulatory Services STABLE, ' Thomas R Geiler,Director 039. u,� 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 7, rA.9 pvpy �,4 use , as Owner of the subject property hereby authorize V-4e4 � &Os(r Ve' lu YV to act on my behalf, in all matters relative to work authorized by this building permit application for. (Address of Job) ? l U jSnature of Cwnv atdf Print Name if Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. Town of Barnstable Of I"F royti o Regulatory Services Thomas F. Geiler,Director BMxrtsT,MLE, 9�P ; 96 - Building Division _ lACD Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print- DATE: JOB LOCATION: ' number street village "HOMEOWNER": name home phone# work phone fl CURRENT MAILING ADDRESS: city/town 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 "homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements., Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1 -Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to d4 such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when.the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is"a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community.. n•\wPF1LESTORMS\homeexempt.DOC From:Erica Barrett FaxID:OLDE CAPE COD INSURA Page 2 of 2 Date:6/14/2010 10:04 AM Pag � y IS CERTIFICATE lS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE ERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED Y THE POLICIES BELOW, THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN i HE ISSUING INSURERS AUTHORIZED REPRESENTATIVE OR PRODUCER AND THE CERTIFICATE HOLDER. MPORTANT: If the Certificate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed. If SUBROGATION S WAIVED, subject to the terns and conditions of the policy,certain policies may require and endorsement A statement n this certificate does not confer rights to the certificate holder in lieu of such endorsement. PRODUCER Old Cape Cad Insurance Agency Inc 296 Winter Street Hyannis,MA 2609 COMPANIES AFFORDING INSURANCE COMPANY A GRANITE STATE INSURANCE COMPANY INSURED Michael Meagher 97 Emerald Street e Mamtons Mills,MA 02W-0000 THIS IS TO CERTIFY THAT-THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED,NOT WITHSTANDING 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 THE POLICIES DESCRIBED HEREIN IS SUBJECT TO.ALLTHE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES,LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, LTR rme OP 91 RANCE PC OLICYIFFICIM DATE POLICY EXPIRATION DATE A WORKERSCOMPENSATION D EMPLOYERS'L IABIL nY LIMITS E PROPR IETOR/ PARTNERSIEXECUTIVE e OFFICERS ARE: INCLoEXCL❑ '6619858 11/09/2009 1 11/09/2010 ATUTORY LIM ITS OTHER CQvwago Applies to MA Opamton a Onty CH ACCIDENT $ 100100 CEASE POLICY LIMIT $ W0,00 iSEASE-EACH EMPLOYEE 100 00 DESCRIPTION OF OPERATIONS/VEHICLEB/SPECIAL ITEMS RE:THE WORKERS COMPENSATION POLICY DOES NOT PROVIDE COVERAGE FOR MICHAEL MEAGHER CERTIFICATE HOLDER CANCELLATION TOWN OF BARNSTABLE : SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORETME BLDG DEPT EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE 200 MAIN ST WIHTE THE POLICY PRO+nSONS. HYANNIS, MA0260t AUTHORIZED REPRESENTATIVE Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registration: 162938 Trig 283438 i Expiratron: 4'/27/2011 `y TYPe DBA MEAGHER BROTHERS CONSTRUCTION MICHAEL MEAGHER JR. i" 97 EMERALD LN .r MARSTONSMILL,MA 02648 Admioistratar `' } �lussuchusctts - D clr►rtrncnt of Puhlic Suft t� 9 Board of Buildnm" Regulations and Standards Construction Supervisor License _ License: CS. 102260 "--777 Restricted to: 00 JL MICHAEL MEAGHER JR 97 EMERALD LANE MARSTONS MILLS, MA 02648 Expiration: 1115/2012 f T r#: 102260 t nnuuiasiwcr , License or registration valid for individul use only before the expiration dale. If found return to: Board of Building R lations an tandards One Ashburton Pl `e Rm 130 Boston,Ma.0� 9 8 wy r — N valid withoa si t � � ponce b'1 o N qugowl �} �! som 7 —mm"Wot ,ate ,u�Y R CADDY G/o�JQART m Vt i T• tv Qj slool f } t C,C, g / i7fD SET FM f o g d.etkme nn a n�d � " lliffY g n FM as naa M r SAIZA TAME REGISTRY 0� DEED�v BARNS _ ". gi - - �f- a - �. .. /fOt7/1!3 ;a Meadow u. �- /1017/N4 �. o 3 N 1 TO BE 4. •�' � REuolfn � m ft Y / FR,yE U11FI11/G Pry"'d 1"t �ll r LPL ��/�! F m �_ s 19VI.20,w 58Iiv5'37•'� a te-= /1017AC - 263�..91_ S.lL --iv �' pots S aide ::-- MIX . . SHAPE FACTOR 16.1fL 587 � Ir l A cotwt fu ' 0 1 ll .3 °11EIlA1C o¢ ? I I M/6 ' N n I N o m. cABOT ,W to 34• 00 SDO-tz' Cg 10_ZY FNO. o / 79.526 9.;tfL uplord / T \ - .HARRIET R CABOT. o 4.747 aaR.reHmd / o •'4 C.B.\ .%FIDUCIARY CA E ¢ . ao _ 1.93.oces totol . SET N a, CAr $ 0 0� :'V �• Fjy2�i o � ' a R/0. ,�' . . SET - CIL - - im- .O r flagged f - �S� gib 1t F �etland� � _gyp`.. � � � � � iS7? •"� $ C.B.. po F71D.A �� IL } S15-zi,05^w AL WrA CEL - AL&AL co =�o� ci Q�J C�• O . �A 2p!� xa t "G 11�?k(� SAL__---- . 6'2d"G� BARNSTABLE REGISTRY OF DEEDS sr� JA a> to 0.�)-nw�- - � yl . auuvsi'ns� - The Town of Barnstable '�" . �' Regulatory Services e E1 Thomas F. Geller,Director Building Division Elbert UIshoeffer, Building Commissioner 367 Main Street.Hyannis MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion. improvement.removal,demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence of building be done by registered contractors.with certain exceptions,along with other requirements. O Type of Work: Estimated Cost i Address of Work: UI T - Owner's Name: C Date of Application: c�3 I hereby certify tiiat: Registration is not required for the following reason(s): []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 appI a ermit as the age f the owner. 3 Date Contractor Name Registration No. 31z3 OR Date Owner's Name q:forms:Affidav Jio CLM App.ma 1 TabL.LZ2.2b(aoaaa� Prarripdre PszkaM for 06 and Twe-Fsmidy R=Wgmdd Ecildla Jff,,d with Focal Faso 8'I&wduM I 11fmmuM ai= 8 tllaaag Ceilia8 waII 11loar g Slab Ke�ayt:miia3 Arm'(K) U-vim R v:lrr� &-"d el Rrvatue� wau Plana= &vi' 3"1 to 690 Hndnw Deem D&W Q 12% I 0.40 I 3E 13 19 10 I 6 I Normai R 12% OM I 30 19 19 10 I 6 I N S I=. I 0s0 3E 13 19 10 I 6 I IU AF UE T 13% 036 3E 13 21 WA ( WA ( Norms! U 12T p 46 3E 19 19 10 I 6 I Norma! v Iri. 0.44 3a 13 1 21 WA I WA CAME w 13% 1 dM 30 19 19 1 10 I 6 u AFUE X IE%. I 032 3E 13 25 1 WA WA I Norma! Y IE•/. i 0A2 3E 19 25 1 MIA 1 WA I Normsl Z 18% 1 0.42 31 13 19 10 I 6 I 90 AFUE AA IE7. 1 d5a ( 30 19 19 10 I 6 I 90 AFETE 1. ADDRE. S OF PROPERTY: PLJ (� 2. SQUARE FOOTAGE OF ALL EXTERIOR WALLS: 3. SQUARE FOOTAGE OF ALL G —A=G: 4. %GLAZING AREA(#3 DIVIDED BY#2): S. SELECT PACKAGE(Q AA-see char above): U jj NOTE: OTHER MORE INVOLVED METHODS OF DETERMINING ENERGY REQUIREMENTS ARE AVAILABLE. ASK.US FOR THIS INFORMATION. BUILDING INSPECTOR APPROVAL: YES: NO: for=4990303u 780 CMR Appendix J Footnotes to Table J5.2.Ib: Glazing area is the ratio of the area of the glazing assemblies (including sliding-glass doors, skvlights, and basement windows if located in walls that enclose conditioned space, but excluding opaque doors) to the gross wall area, expressed as a percentage. Up to 1%of the total glazing area may be excluded from the U-value requirement. For example,3 ill of decorative glass may be excluded from a building design with 300 R=of glazing area. 'After January 1, 1999, glazing U-values must be tested and documented by the manufacturer in accordance with the National Fenestration Rating Council (NFRC) test procedure, or taken from Table J1.5.3a. U-values are for whole units: center-of-glass U-values cannot be used ' The ceiling R-values do not assume a raised or oversized truss construction. If the insulation achieves the full insulation thickness over the exterior walls without compression, R 30 insulation may be substituted for R-38 insulation and R-38 insulation may be substituted for R-49 insulation. Ceiling R-values represent the sum of cavity insulation plus insulating sheathing(if used). For ventilated ceilings, insulating sheathing must be placed between the conditioned space and the ventilated portion of the root 'Wall R-values represent the sum of the wall cavity instilatian plus insulating sheathing (if used). Do not include exterior siding, structural sheathing,and interior drywall.For example,an R-19 requirement could be met EITHER by R-19 cavity insulation OR R 13 cavity insulation plus R-6 insulating sheathing. Wall requirements apply to wood-frame or mass(concrete,mas to wall constructions,but do not apply to metal-name const ruction. 'The floor requirements apply to floors over umconditioned spaces(such as unconditioned crawlspaces, basements, or garages).Floors over outside air must meet the ceiling requirements. `The entire opaque portion of any individual basement wall with an average depth less than 50%below grade must meet the same R-value requirement as above-grade walls. Windows and sliding glass doors of conditioned basements must be included with the outer glaring. Basement doors must meet the door U-value requirement described in Note b. 'The R-value requirements are for unheated slabs.Add an additional R 2 for heated slabs. ' If the building utilizes electric resistance heating use compliance approach 3, 4, or S. If you plan to install more than one piece of heating equipment or more than one piece of cooling equipment, the equipment with the lowest efficiency must meet or exceed the efficiency required by the selected package. 'For Heating Degree Day requirements of the closest city or town see Table J5.2.I a NOTES: a) Glazing areas and U-values arc maximum acceptable levels. Insulation R values are minimum acceptable levels. R-value requirements are for insulation only and do not include structural components. b) Opaque doors in the building envelope must have a U-value no greater than 035. Door U-values must be tested and documented by the manufacturer in accordance with the NFRC test procedure or taken from the door U-value in Table J1.5.3b. If a door contains glass and an aggregate U-value rating for that door is not available, include the glass area of the door with your windows and use the opaque door U-value to determine compliance of the door. One door may be excluded from this requirement(i.e.,may have a U-value greater than 0.35). c) If a ceiling, wall, floor,basement wall,slab-edge, or crawl space wall component includes two or more areas with different insulation levels, the component complies if the area-weighted average R-value is greater than or equal to the R-value requirement for that component. Glazing or door`components comply if the area-weighted average U- value of all windows or doors is less than or equal to the U-value requirement(035 for doors). ESTIMATED PROJECT COST WORKSHEET LIVING SPACE Value (high end construction) square feet X$115/sq. foot= (above average construction) square feet X$96/sq. foot= (average construction) square feet X$57/sq. foot= GARAGE (UNFINISHED) square feet VS25/sq. foot= PORCH square feet X$20/sq. foot DECK square feet X$15/sq. foot= OTHER square feet X$??/sq. foot= Total Estimated Project Value e66 f � 0 U-7—&I l T 7` 3.o a� � s os , t ne LOmmonweaWl of Massachusetts y' Department o�'Indttstrial Accidents - - 600 Washington Street Boston,Mass. 02111 Workers' Compensation Insurance davit nam 5 4!� location: M/25 testy ❑ I am a homcaw=p �g all wc&�� hone# I am a sole wom etor and have no one is an9 caaacitr ❑ I am an empiover dmg easatioafor ..�. � on this 'ob. ..:......:•;::K{},.};a>•i::'•::.:::.::...:iC•.v... vv.:. ...vv V:t�?:K:Yr?OS•}v+?:?:::, .v... � �i{;C6{}}}:.v::•^•;.}hnti•{.}.::r::.tis.t...y.}ti::'C.i'•:•}7: v:::v.:: '.:':..::,;..:.. tOTIID8DY'flIIlaC:'.' ,..,,.c»1.:,•,.:•.i;..." p`:4�rny:}• r r �a� :<h32�?�`r� } s < +�<o>i .. . ..........: ............. ............ ... ...:.:::n:•:::.::::.... :.. ti;•:::ti}n}}}}:{v:t-.^'iv:��+:�\.':.?:i{{a". .v.:{'i:":;{rCdth�:i;•.,v.:v..:::::r ..........,;. ....^.::v:{rtix:: •}}:::.:.......:. ..:.•. :.,,:•.::.......?.�?:.'!.}v.;Lt:t}nn,3:J:::....w.{:•)iMl+xiNk .. •.?.+.3....?..?...... ......{i:••:.:'.:.:;?:...;.. .. ...... ...:................x:v;......,;.;.:..,..r.::.:.. .ti,., .a, ...;... :v.v;:.... .:.•., :v:.:;}.}},v,:?w.-:/:M.}:p}h\: .: .....::.v:•:.v:n:v....... 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AL A AL 7C b. $ GS AL &AL—. . � l 315Z�'Off1i N' moo, COOT no. /O { er A; d G Cr,n� -- - �P MlV�:1� � 6lbi. �•��1�It� tl 1�l�y __._...... —_ _.- ' _. .— _17/. HONE INPROVENENT CONTRACTOR Registration: 104246 Expiration: 7113102 Type: OBA THONGS R. NORSE REMODELING Thomas Norse aoMINIS7RAT0 � 393 Lakeshore Or i Sandwich NA 02563 GTE BOARD OF BUILDING REGULATIONS' ; License:'CONSTRUCTION SUPERVISOR r Number. CS 009474 Birthdate 0&Wl957 _ Expires 6il2 001 Tr.no: 4905 _ ;Restricted To: 00 THOMAS R MORSE _ 393 LAKESHORE DR` SANDWICH; MA 02563 r % AdfniniZt or The Commonwealth of Massachusetts —••� Department of Industrial Accidents " �° ' � �= _= OfBceoflo�esdgadoos 600 Washington Street r -_ Boston,Mass. 02111 - workers' Com ensation Insurance Affidavit name: � �( location- hone city ❑ I am a homeowner performing all work mvsel£ Allow"J, am a sole Proprietor and have no one ing in anv capacity /%%///%/// //%l0 � y'" %/ // %/G/vll/,%G ''/ //// /// Gi, ir�"%�//////////O//////M����� %//OT//�///////%////O/%�i, workers ensation for my employees woriang}on this job. as 1 prcmding CO P....::::.:::.:.,_:::: .:::::::::.::::::.:.::::::::::::::::.:::::::::::::::::::::::::;::;:?.> ?;< I am emP.o9ef.....:.::.:::.::.:::::::::::::::.:::::....:.:::::.::::.::,.. .:..:::: ::::.::::::::..:::.:::.:::.:::....::::.:::::::::::.:.. :.:..,:::.:::.::::. :::::::::::::.:....::::::::::.::: ::.:..::.::.:.::::::.... ....... anv Hero `s`:: ..........:::.....,:::;:.; .::.;.:::.::.:.::::... .............::..::..:.:::::::::...................::::::::::.... .......:. . ;:. erne .. ......:......:,.....:.:::..::::::::......:...::::.-. # . am a sole proprietor, tmerai contractor, o homeowner(circle one)and have hired in the contractors listed below who have olices: workers ..,::.:.....:::::::, :.::::.::::::.}?.:;.:>:->:.;.;..}:.:?.;:.}?.}:.::.:;:...:.:.....:???-::: :.....«<: >:::;;:::?:;<:>}:;;«.;:.:?.;;:.;: folio comp...................p.::::.:::::::::::.::::.. . .::.::::.:... . ::. the :::?.:}:<?.:.:::.::.::::..}:}:::?.}};;:.;:::}}}}:.::.::::?:.::.::.::::.;:.}:.}:}}:;.}:.}}:.:.:?;?.::::.:::.}:<.::.:} .......::.::.:.::.:..... ................::.:.... ;. x ......... ......... ........ . . .... ... . . ....... ter. ..:.:r...:: .::.:,:::::.}':::.}':::::.�.�:::.::::::::::::::::..?.:}..}}.. ............::.. tttttlre .......?..:.... .... ..'fin.. .. .... .. r:x.... ... hi.:::::..,..•... w::.,:,}.•}' .........r ......... ....... v-v,x,• r. .. rxwxr ...... .:.......... v::::. :..:::•. �.;.;:}: :.. .............. ............ ....... rib. ...... .r..... �x .........nn......•r:•:... .... ... :.... •• 'i.:}}..... _ .::.._:.....-: .:.......:.:.. ...:......:::........:•::.�:::.... .....::::::::::•>�•?:••:::>:•::i>::i•:i iSiir:::ii:::i:::?:;:�}:�:;:ii::•>:?:iii:•i ii:•xr••�:,•' :.:::�-:iii-•}:�::t�:.�:., .............,..:....:,......... ... .... ... ..... ................ ..:•::::.....h...;v•.v::• w::::::.,...:::0+:????•::..............:•.v::.•::!?•}%?•}::a:. :nH......;?}ik.::i::v::}:nw::::?... ..... ... ... , ..... .......:::::::nw:::•• ... x...... ...... ..... ...r .. ......:....v..n..r Y...r.. ..x:?v:.v:{•}::yi:?i?¢::¢:v.}:?•i:..:n..y:::.:vit:wv-.}vw:,:.,-...::.�::::: ........ ......... ....n::• ...............\..........::v.:.............r::v:.}::::nw::rn.. ..Y.-1v:t:.:4:vx{::::•.- ..:v...:..:............... ??q,}}r.:::.}`:?•:�:•}:::v.v :::.....,.:.;0.....vn-L•}}}YY}}:bi:-i}}:-}}:::v:.v::::::a:•{•�?•$}:?•.v::•:v??•}Y:.},'•:?:�:•}:rw{??:4::��::•.:????:^:.:::....::.. o,��• .. ` $:: Y ::+S5: :::::::::i:%:+.ii::r:t: ::::: 5: :::2:::r:: ::::::::::: %;::<:;:r:::'•::::::::'•:%:ii '%:iifiii: >::;::;;. ;rater ..... X. ........... .. .. "n .:............... 0 ........................................ ................ ................................. lieu 0 under Section 25A of MQ.152 can lead to the imposition of criminal penaltie+of a fiat;np to S1,S00.00 and/or Fanare to secros coverage required one yam,imprisonment as wen as civil penalties in the form of a STOP WORK ORDER and a fine of S100.00 a day against me. I m derstand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certify lhepains and penalties ofp9d7W that the information provided above is trtr�and eorrcd `� Date q Sigaatnre Print name Phone# ,�1����l9 i r ly do notwrite in this area to be completed by city ortown oiScialpermitNcwe# - QBuiiding Deparbnent ❑See e t mg$oani response b tared ❑Sdectrnen'a Office ❑dheckif immediate respo req . ❑Health Department contact person: phone#; ❑Other (terued 9/95 P1N 1 - 1 :11 - 1 . q • •1/ • �11111 • a . . . . - , • . 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The Town of Barnstable MxivsenBU& MAS& �0 Department of Health Safety and Environmental Services 1659. �Eo +A Building Division 367 Main Street,Hyannis MA 02601 Office: 508-862-4038 Ralph Crossen Fax: 508-790-6230 t Building Commissioner Permit no.— Date— AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the`reconstruction,alterations,renovation,repair,modernization,conversion, improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. a V Type of Work: 1 �1. Estimated Cost o� �"'�C�a`���'Vy� T �1 Address of Work: R 9'�� 1/1�YY�- �/`� l C�"tv►"P" Owner's Name: l./ ►V Aj RAJ S l-P, Date of Application: I hereby certify that: Registration is not required for the following reason(s): ❑Work excluded bylaw . . MJob 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 for a permit as the agent a owner: (ed. Date Contractor Name Registration No. OR Date Owner's Name q:forras:Affidav 16 'aO 1!,:-:14 AFIEI=I c_:AH Pi IOLS TEL 50 6-O 7 92 P. 1 AMERICAN GON11 E POOLS, RI REG NO.217 A DIVISION OF AMERICAN SWIMMING POOLS, CORP. CT REG NO.HICOOSEA299 e • 540 ARCAnr AVENUE (CORNER TAUNTON AVENUE) MA REG NO. 100284 SEEKONK, MASSACHUSETTS 02771 •-••-•'••"•' TEL.(508) 336.7577 FAX (508) 336-8792 ESTIMATE FOR SWIMMING POOL NAME 7twL wJPI't� IrJ�11 /L rL"�.1 L'/ DATiw -f� MAIL ADDRESS CITY _ __. ._..,._._. n _ PHONE�'-tl JOB ADDRESS t� /'�/`I>�6►3 l /1�� COJU _ ✓a- _ POOL SIZE X YO Ott DEPTH S 6`r TO VY _,SHAPE= <"I f19�1G,Ul� CONSTRUCTION SPECIFICATIONS: 1. Contractor's engineered structural plans and specifications for pool. . . . . . . . . . . . . . . . . . . . . . . . . . . Included 2. Contractor's plans showing layout of pool . . , . . . . . , . . . . . . . . . . . . . . . . . , . . . . , . . . . . , Included 3. Contractor to lay out pool before excavation (approved by owner) . . . . . . . . . . . . . . . . . . . . . . . . . . . . Included 4. Excavation of pool and removal of soil , • . , • • • . . . . . . . . . . • • • • • • • • • . , . . Included 5. Contractor to hand form and shape pool. . . . . . . . . . . . . . . . . . . . • . ..• . . . . . . . • • . • • • • • • • • . • . • . Included 6. Engineered steel reinforcing throughout pool structure : . . . . . . . . . . . . . . . . . . . . . . . Included 7. Engineered concrete,gunite structure to meet or exceed city or county codes, Owner to water cure concrete-gunite shell and fill pool after plaster. . . . . . . . . . . . . . . . . : . . , . .. . . Included -"-- a. One f'band-waterline tile; .- American Custom Tile 7- Other Tile n Size & Color. �y /34- c610$07y. . . . . . . . Included 9. Deluxe safety grip coping . 14OMf. . rl Cantilevel Deck Apron . /10)-!0 . . I-1 , . . . . . . . . , . . . 10. One set of shallow end steps . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . . . , . . . . . . . . . . . . . . . . . Included 11. Interior finish to be waterproof Marblelte plaster . . . . . .k/ft lK. . . . . . . . . . . . . . . . . . • . • . . . . , , . Included 12, Three to six man pIr eter crew (had troweled) . . . . . . . :: . . . . . . . . . . . . . . . . . . . . . . . . . . . . Included 13. Clean up after each phase of construction , . . , . . . . . . . . . . . . . . . • • • • • . • • • • • • . • • . . Included 14, Supervision of construction . . , . . . . , . . , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Included FILTER EQUIPMENT SPECIFICATIONS: 15. Approved Deluxe American Filter ►'1'j-331D . . - - • • • • • , . . . . • • • . . • . . . . Included 16.Weatherproof pump and motor with hair and lint strainer � `��}_ �j P . . . . • . . . . . Included 17. Complete hook-up of all water lines from filter to pool. . . . . . . . . . . . . . . . . . . . . . . . . . . Included PL.UM61NO SPECIFICATIONS: 18. Plumbing,non-corrosive type, including face piping. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Included 19. Skimmer with self adjusting weir a�, . . . . . . . . . . . . . . . • . . . , . . . . . . . • . Included 20. Pressure return lines -:n; included 21. Concrete pad for pool equipment . , . . - ' -- , , . . , . . • . . . . . . . . . Included 22. Main drain receptacle with grate�-- t� ` • . . . . . . Included 23. Lest basket In skimmer chamber . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . . Included 24. Waste Water Disposal r!ipFitting on Filter, rl Irrigation, r1 Drywall, O Sewer, I7 By Others MISCELLANEOUS SPECIFICATIONS: 25. American diving board Size 26• American Ladder No. _____,_Model No. Swimout f>t✓ 27. Approved Marine Cite, 500 watt,heavy duty construction . . . . , . . . . . . . . . . . . . . . . . . .. . . . . . . . . Included 28. Approved deck box . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ., , . . , , . . , . . . . . . . . . included 29. Deluxe Cleaning Tools, includes 18"Nylon Brush, Hand Skimmer, 16' Pole . . . . . . . . . . . :. . . . . . . . . Included 30. Instruction on pool equipment and maintenance procedure . . . . . . . . . . . . . . . . . . . . . . . . . . . . Included 31. Initial chemical dosage and water treatment Instruction . . . . . . . . . . . . . . . . . . . . Included 32. Public liability And workmen's compensation insurance . . . . . . . . . . . . . . . . . . . . . . . . . I . . . . . . . . . . IncIU4ad 33. Pro e y damage negligence Insurance to pool during construction . . . . . . . . . . . . . . . . . . . . . . . . . . . Included 3V nl _ . =- esic - ,7 -B Pnai PF16 f7t7wt'rd!_, OPTIONS: 1. Heater type IC Model No. 4f� �.� STU rating 017d PDX. , . . . , . .a�,O,Q fV O 2. Waterlines connected to heater by Contractor . . . . . . : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Included 3, Heater and gas permit jgtn Gas Llne 0Uip41?A L.F., venting of heater , 4. Pool Valet In Floor Cleaning System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 00 Polaris Vac Sweep. . . . . . . . . . . . . . I :QO Kreepy Krauly . . . . . , . 5. Chlorinator . . . . . . . . . . . . . . . . . . . . . . . . • • . • . - 6. American Pool Sias- Model No. 7. Winter Swimming Pool Cover . . . . .L-CU F . . . .�. . .C�fTp.r"-t . ,!' 7.FS.�t. . . . . . . . J S. SPA- Size r iotdt7 MP O o v DO 9. Handrail 71k-0v� due, 1MION 161r^rOp V omvinoxuiea� ��.aaa�rc/u�ae� BOARD OF BUILDING REGULATIONS' License:CONSTRUCTION SUPERVISOR Number: CS -- 009474 _ B�rthdate•,08f22/f957 _ .. Tr.no: 4905 y Rristed'To: o0 THOMAS R.MORSE 3` 393 I.AKESHORE DR - SANDWICH, MA 02563 Administrator; OME'IMP OVE ENT TAC OR r. - r L. S'an ch��Q256 z ���Je e: l I' p (Cis --Nis C) 7� _ ;-o t/-N Duj. yl_� I t /u� v�A` TOWN OF BARNSTABLE BUILDING PERMIT I PARCEL ID 036 044 001 GEOBASE ID 42946 ADDRESS 49 PUTNAM AVENUE PHONE ZIP - LOT BLOCK LOT SIZE DBA DEVELOPMENT DISTRICT CT PERMIT 41202 DESCRIPTION SIDE/DECK/REMODEL/PART DEMO/REBLD SEWPT#8243� PERMIT TYPE BREMOD TITLE RESIDENTIAL ALT/CONY CONTRACTORS: MORSE, THOMAS Department of Health, Safety ARCHITECTS: and Environmental Services TOTAL FEES: $124.00 DIME BOND $.00 CONSTRUCTION COSTS $40,000.00 434 RESID ADD/ALT/CONY 1 PRIVATE P t STABLE, +' MASS. �► 1639. �0 Ep�l 6 BUILDING DIV BY DATE ISSUED 09/21/1999 EXPIRATION DATE I e . TOWN OF BARNSTA�LE BUILDING PERMIT PARCEL ID 036 044 001 GEOBASE ID 42946 ADDRESS 49 PUTNAM AVENUE PHONE ZIP - LOT BLOCK 4 �, LOT SIZE DBA DEVELOPMENT. DISTRICT CT PERMIT 41202 DESCRIPTION SIDE/DECK/REMODEL/PART DEMO/REBLD SEWPT08243, PERMIT TYPE BREMOD TITLE RESIDENTIAL ALT/CONY CONTRACTORS: MORSE, THOMAS Department of Health, Safety ARCHITECTS: r` and Environmental Services TOTAL FEES: $124.00/ SINE 1q�, BOND $.00, � Qi► I CONSTRUCTION COSTS $40,000.00 434 RESID ADD/ALT/CONV 1 PRIVATE P STABLE, 1639. ED Mp/A -_ BUILDING DIVI M& BY DATE. ISSUED 09/21/1999 EXPIRATI TE 4 r J TOWN OP' rn.A.RI STABLE BUILDING PERMIT PARCEL ID 036 044 001 GEOBASE ID 42946 j ADDRESS 49 PUT.NAM AVENUE PHONE711E k. LOT inwC K LOT SIZE DLA DEVELOPMENT.1 `` DI.STRIO`T PERMIT 41202 DESCRIPTION SIDE/DFdK/RFMaDEL/PART ENO/R BLD S0,PTa1524& PERMIT• TYPE BREMOD TITLE RESIDENTIAL AL`C/CON T CONTRACTORS: MORSE, TH7MA8 Department of.Health, Safety AR.CH.ITCTS: and Environmental Services TOTTYAyyL FEES: .124.00 p1r� lli�l:i.J .$'.(}I CONSTRUCTION COSTS $40Y000.00 * a 434 REBID ADD/ALT/CONV PRIVATE R srABi.E; MASS. ` BUILDING DIV LION BY DATE ISSUED 09/21/1999 EXP:IRA`PIPN A ATE .000 I r THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET,ALLEY OR SIDEWALK OR ANY/PART'THEREOF, EITHER TEMPORARILY OR PERMANENTLY.EN- CROACHMENTS ON PUBLIC PROPERTY,NOT SPECIFICALLY PERMITTED UNDER THE BUILDING.;Obbt,MUST BE APPROVED BY THE JURISDICTION.STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAYBE OBTAINED�FFiOMTHE DEPARTMENT OF PUBLIC WORKS.THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. MINIMUM OF FOUR CALL INSPECTIONS REQUIRED FOR ALL CONSTRUCTION WORK: APPROVED PLANS MUST BE RETAINED ON JOB AND WHERE APPLICABLE, SEPARATE 1.FOUNDATIONS OR FOOTINGS THIS CARD KEPT POSTED UNTIL FINAL INSPECTION PERMITS ARE :REQUIRED FOR - 2. PRIOR TO COVERING STRUCTURAL MEMBERS HAS BEEN MADE.WHERE A CERTIFICATE OF OCCU ELECTRICAL,PLUMBING AND MECH- (READY TO LATH). t PANCY IS REQUIRED,SUCH BUILDING SHALL NOT BE ANICAL INSTALLATIONS. 3.INSULATION. OCCUPIED UNTIL FINAL INSPECTION HAS BEEN MADE. - 4.FINAL INSPECTION BEFORE OCCUPANCY. VISIBLEPOST THIS CARD SO IT IS BUILDING INSPECTION APPROVA S PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS V'`e4 f 0ck+ 2 2 2 Q1. :ts. 3 1 HEATING INSPECTION APPROVALS ENGINEERING DEPARTMENT 2 BOARD OF HEALTH OTHER: SITE PLAN REVIEW APPROVAL. 6 WORK SHALL NOT PROCEED UNTIL PERMIT WILL BECOME NULL AND VOID IF CON- INSPECTIONS INDICATED ON THIS THE INSPECTOR HAS APPROVEDTHE STRUCTION WORK IS NOT.STARTED WITHIN SIX CARD CAN BE ARRANGED FOR BY VARIOUS STAGES OF CONSTRUC- MONTHS OF DATE THE PERMIT IS ISSUED AS TELEPHONE OR WRITTEN NOTIFICA- TION. NOTED ABOVE. TION. . BUILDING PERMIT i5:1\ .._ The Commonwealth of Massachusetts F _= -- Department of Industrial Accidents Office ofl�esdooffoos . t 600 Washington Sheet � ; Boston,Mass. 02111 . Workers' Compensation Insurance Affidavit name: location: 14J--e-1 . U�/V �CC, — ci 1 .r �` hone# I' V . ❑ I a homeowner performing all work myself. . I am a sole rietor and have no one worli>s in env achy ❑ I am an employer providing workers' compensation for my employees working on this job. COIDp8nY n .. »<>»> - `Sig ii'`i i:i i%i i ii_ ::'ii i:i : ....: F•:??::;;.; •. .;:.:::•:::::::r.:...•;::::•::•::;;;: address.:: .. :..::.:... . .......... „...... .; ;:::>r:.;;;::;::.:.:.::.,::: .:; is <'::'f:;it%%:<i::::::<:miiO"le i 7:-":'i:i::%::::::;;:;:> i;i;:;i c;;?::;;r;:: i::i%?.i:i ';:::::.:::'r...=: tits . :.....: :....:. ::::.;:: . > < i .,:..::..:. :.::.:;:.;;:.;:.;:.::.;:::.;:: al Cv �M 4� insurance ."....:;: :.:::,::;.;.:::: ....... . ::... :::::;>::;;:::;::;;;:.>:<::, :::>::>:::.::. ::..;.;>;;:;;;:....;;:>:;;;:::: I am a sole proprietor, eral contractor,or homeowner(circle one)and have hired the contractors listed below who the following workers' co ensation policesr n cumoanvgm- ; :y:S«`'z> <z [': ' j : ' i t ti `�- - : :::a i>::2>:: i<::::>� :%'?i?=±i= 'i 2i ;<<����� 2'i ':: .....i< '`:i'` i r i<i±i5addres _............._........ ......_... ..... . . _ . __................:.::......:::::::............::::.:::.....::::.................................... :............................................................................... ::::.......................::::::::::.::::.:::::::::.::::::::::::::::::::::::::.":.::::.::::::::::::.::.:::.::::;::::::::::.::.;;::...................................... ...........:::.�:•..............:•::.:::::•.:::.................:.....:..:.:..:•::::::.:. ..................... .....................................................�.�::•:::::.'�:.:�r•::.}. ... :::::::::::.........:......................... .......... ............................................................:::::::::::::::::::.... :.....................:.....:..:...........:....:..;.,.......::::;::::::::::::..;..:•::::•:..:.::.. ......:.....:..........:............b one y.,. ....:::.:::::.:: ........::::.::%; .............................. � .. .. ... ........ .........: .................. ............ ,r;...:� :•:::.::::::::::::::::::::::.�:::::::::...................... .................. .......................................:...................:...........:..............................................................................................:....... ......., .....,....... campsny>name:..:<:::::<....:..... ;:- «. ...... :......<.-::. .:.. ::.:.. :::.,"'. :::.:::.: ::.:::.::•::. address: :d:::.: ::.:::.:::.:.::........::.:::.:.::..::::::...:::.... ...::.::..:...:.:.:.:..:::..............:.::.::.:::.::::.:::.::................. City' .. :;Fy:;;'::::: ::<FFi:`::::1. ::F::i:%:: :;F::FF:;%•::>:�::•r:::::•::•>::;?;:FF:;>;:::Fr'R;:::F:,::,:::::::F;F:;::;:;::;:::�:•::;::::•:�::•::•::-r::;::. ::::i:F: '' �/ gaflnre to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of 5100.00 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 verincation I do hereby c fy tainy and penalties of perjury that he information provided above is&W.and co ed ki PDate �� �qY - Signature l ! — Print name d �S A ® Phone# 7i�—� �_ offidal use only do not write in this area to be completed by city or town offidal City or town: permiWcense# ❑Building Department ❑Licensing Board ❑check if Lnmedlats response i,required ❑Sehxhnen's Office ❑Health Department contact person: phone#; ❑Other Devised 9195 PIA) - . II 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. r, 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 piii i llicense mimber which will be used as a reference number. The affidavits may be retaziR 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 Office of luesugadons 600 Washington Street Boston,Ma. 02111 fax#: (617) 727-7749 phone#: (617) 727-4900 eat. 406, 409 or 375 �VEr The Town of Barnstable LMWffABM �m� Department of Health Safety and Environmental Services Building Division 367 Main Street,Hyannis MA 02601 f ` ' 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,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: Estimated Cost c GZ Address of Work:__ � pcJ A.1 oQry 1 q� Owner's Name: a! b/9/l�j�J 04k)W. Date of Application: q. 0 \ I hereby certify that: Registration is not required for the following.reason(s): 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 permit as the age of the owner: 'Y1�1 l o y Date Contractor Name Registration No, OR Date Owner's Name q:fortns:Affidav Y ",V^�nsiea.-.' 'a�Tw.�-c.+.w.T^.�.rw+'fw,.t• �-r� �� �,�(aaoadEuaella y IMzr PROVEMENT CONTRACTOR Registrat>.on 104296t r TyPe = OBA ry'} j EzPiration 07/13a 00 �; THOMAS R MORSE REMODELING X's Thon. as R ..Morse Lakeshore Or j c gpM1N1DR Sandwich MA`02563 F ;Jfte L/pp�ryNNNZIOCQU/L ���[ZC/tU4P,�b BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number..,CS 009474 Birthdate: 08/22/1957 Ekpires:08i=001 Tr.no: 4905 RwWctedTo: 00 � THOMAS R MORSE" 393 LAKESHORE DR G.��•a► SANDWICH, MA 02563 Administrator r` � HOME IMPROVEMENT CONTRACTORS REGISTRATION Board of Building Regulations and Standards One Ashburton Place - Room 1301 Boston, Massachusetts 02108 | IMPROVEMENT CONTRACTOR strat ion 100740 Expiration 0b/23/94 - PRIVATE CORPORATION] HOME IMPROVEMENT CONTRACTOR Registration 100740 Capi zz i Home Improvement , Inc . ' Type - PRIVATE CORPORATION Thomas Capi zz i , Sr . Expiration 86/23/94 1645 Newton Rd. Cotuit MA 02635 50uu Homo {mpmvemeA/ loc Thomas Capbu/ S/. — 1645 Newton Rd. '----- ("m/t »^ N/ux5 ' � � � � . | ' | � . ' � ' ` . / Assessor's office(1st Floor): Assessor's map and lot number /V ® f<l. _ , � wP�at:TNIt>o`. Conservation Board of Health(3rd floor): Sewage Permit number lira»� ru& Engineering Department Ord floor): �o o639. \�a° House number tIto NO 6' 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 APPLICATION FOR PERMIT TO �^� TYPE OF CONSTRUCTION �-- G 19 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location Proposed Use Zoning District Fire District Name of Owner LE- Address /U i iI/�i9 ot7/�� OZl,4�j Name of Builder AddressZ6 IS—ALVAa),61 �,— Name of Architect Address Number of Rooms Foundation Exterior Roofin— Floors Interior Heating Plumbing Fireplace Approximate Cost 5 C C Area 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 regarding the ve construction. Name 442e6wrA Construction Supervisor's License OS�Z1 Z- HINK.LE, SALLY No 35258 Permit For Re-ROOF '7� r Sirigle Family dwelling _Location 49 Putnam Avenue , Cotuit Owner I Sally Hinkle Type of Construction Frame ? u. r Plot Lot I I I r J Permit Granted August 6•, ' 19 92 Date of Inspection 19 Date Completed 17 19 • 4 : . � � � it � - Development of Regional Impact (DRI) Referral Form Continued DRI.REF.FORM 06/2019 Prior to making any referral, the Commission recommends that the municipal agency contact Commission staff to confirm process and discuss other relevant issues under the Commission’s regulations; and specific to limited discretionary referrals, this discussion might eliminate the potential for misunderstanding about the scope of Commission review under the particular Cape Cod Regional Policy Plan (RPP) issue areas requested. For Mandatory Referrals: Please indicate the review threshold(s) the project meets/exceeds from Sections 2 and 3 of the Commission’s Chapter A: Enabling Regulations Governing Review of Developments of Regional Impact. For Any Discretionary Referrals: A referring agency should provide support about why it believes a project, that does not otherwise meet or exceed a review threshold, has regional impact and thus should require Development of Regional Impact (DRI) review. A municipal agency making a discretionary referral may request DRI review for one or more, or all, the issue areas of the RPP under which the agency maintains that the project will have regional impact (the RPPs issue areas are set forth below). A "limited" discretionary referral is one that requests review under one or more but fewer than all the RPPs issue areas. If a limited discretionary referral is accepted for DRI review, the Commission will limit its RPP consistency review only to those issue areas specified by the referring agency and accepted for review by the Commission. Please indicate below the RPP issues under which the municipal agency seeks DRI review: NATURAL SYSTEMS ______ Water Resources ______ Ocean Resources ______ Wetlands ______ Wildlife & Plant Habitat ______ Open Space COMMUNITY SYSTEMS ______ Cultural Heritage ______ Economy ______ Housing BUILT SYSTEMS ______ Community Design ______ Coastal Resiliency ______ Capital Facilities & Infrastructure ______ Transportation ______ Energy ______ Waste Management ______ Affordable Housing Effect of referral on local board’s time limitation to review an application: For mandatory DRIs, local review and the corresponding time periods for review are suspended immediately upon the Commission’s receipt of the DRI referral and resume upon the Commission’s decision to approve a project becoming final. In the case of any discretionary referral, local review and the corresponding time periods to review are not suspended unless and until the Commission votes to accept the referred project for DRI review. FGRM B - BOIIAING MASSACHDSETTS HISTCRICAL COMNISSIOJ 80 BOYLSTON STREET BOSTON, MA 02116 Barnstable, Massachusetts MRA AREA FGRM NO. CTB 41 cess Barnstable (Cotuit-Cotuit Port) 49 Putnam Ave. Sketch Map: Draw mp showing property's location in relation to nearest cross streets and/or geographical features. Indicate all buildings between inventoried pcopezty and nearest intersection(s). Indicate north . see attached assessors map toric Name Ebenezer Crocker, Jr. House : Present dwelling Original dwelling CRIPTION 1783 Gilbert Crocker, style late Georgian oiitect unknown Exterior Wall Fabric shingle Qltbuildings ice house, wood shed, barn. garage Major Alterations (with dates) porch added c. 1900 Condition excellent Moved no Date ;^reage Setting 4.2 36/44 residential village area A \<^ls&OSZ0li/^0&SZ0 um REFERQicE ^ jSBCXncI^/tZD^LSO •SGS QOADRANGLE Onku -f^ HA SCALE Recorded by Candace Jenkins a:ganization Barnstable Historical Cnmm. Date 1986 NATIONAL REGISTER OUTERIA STATEMENT (if applicable) The Ebenezer Crocker Jr. House possess integrity of location, design, setting, materials, workmanship, feeling and association. It is significant for its associations with the several illustrious families who have lived there: The Crockers, Hoopers and Lowells. It is also important for its associations with and continuous reflection of Cotuit's agricultural and summer resort history. Finally, it is significant as a fine piece of Georgian architecture enhanced by retention of its rural landscape and numerous outbuildings. The Crocker House thus meets criteria A, B and C of the National Register of Historic Places. ARCBnECTORAL SIGNIPIC3WCE Describe ijnportant architectured features and evaluate in terms of other buildings within the oonnunity. The Crocker House is a 2^ story gable roof structure with two interior chimneys. Its five bay facade is centered around the entry and a projecting enclosed porch at the second story. Windows at the first story have been replaced but the remainder are original and contain 6/6 sash; those on the side elevations have projecting lintels. The pilasters on the corners and the entry are similar to those of other Crocker family houses in Santuit (area CTA). There are two ells, one possibly older than the main house and a second, sail loft added with the summer kitchen before c. 1850-60. The porch on the south side and east was probably added in the 1860's by Gen. John Reed, the tenant who was allowed to make any changes he wanted. The window changes in the southwest parlor and the dining room (first story front) were made in 1892 by Mrs. Edward J. Lowell. The interior panelling is comparatively simple, though it is known that the northwest room had a panelled wall, which was so badly altered it was sealed up in 1892 and again in 1950. Except for narrowing the back hall to enlarge that room and altering the northeast bedroom to get a view and access HISTORICAL SIOHFia^NCE Explain the role owners played in local or state history and hew the (con building relates to the development of the commmity. This house shows the further development of the houses built by the Crocker family in Santuit and the growth of interest in the maritime business. Ebenezer (1751-1817) married comparitively late and had his first son Nathan in 1783. It is possible that the house was built about that time as his grandson Gilbert stated and it was certainly there in 1794 when the road from Marstons Mills was completed to what is now Hooper's Landing. Ebenezer served two terms in the State legislature from 1791, which gave him the title of Esq. and Hon and according to his gravestone was considered "an upright and efficient and useful citizen" as well as that "His conciliating manners and active benevolence greatly endeared him to the neighborhood in which he lived." He is said to have built the wharf, now represented by eelgrass near the west fence. His son Braddock added the store, later used as a boat house. The elder son, Nathan Crocker became the first episcopal bishop of Rhode Island and was one of the first of his family to move away. The estate was divided at Old Oyster Road and the western part of the land was not developed until recently. Braddock's daughter Mary Bourne Crocker married Alexander Scudder, ship captain. He was pursuaded to sell the estate to the Boston merchant Samuel Hooper, son-in-law to William Sturgis of Barnstable. This was to enable the captain to take one of the Hooper ships to the Gold Coast in 1849. j Mr. Hooper became the first summer resident. Many well known people stayed in the house J including Charles Sumner and other political figures. Hooper's niece Marian Hooper spent i her honeymoon with Henry Adams in the house. Later, a cousin, Gen. John Reed rented the place with the privilege of making what changes he wished. After Mr. Hooper's death, Mrs. Edward J. Lowell took it over with her husband, historian of the French Revolution BIBLIOGRAPHy and/or REFHIENCES (cont.) Barnstable County Atlases. 18958, 1880, 1907. Santuit-Cotuit Historical Society. Cotuit Library. Barnstable, Massachusetts MRA INVENTORY FORM CONTINUATION SHEET MASSACHUSETTS HISTORICAL CCKMISSION Office of the Secretary, Boston Ccnnunity: Barnstable (Cotuit- Cotuit Port^ Form No: CTB 41 Property Name: ^^^"^^^^se'""''^'' Indicate each item on inventoiy form vtfiich is being continued below. ARCHITECTURAL SIGNIFICANCE Continuedi to the loft the house had had little change which could not be restored. Of extreme importance to the overall significance of the property, is its retention of numerous well-preserved outbuildings, making it one of the two best preserved farmsteads in the town. HISTORICAL SIGNIFICANCE Continued and Hessians. Their daughter, Alice, wife of James Hardy Ropes, professor at Harvard took it over in 1904 and many academic visitors stayed there. Staple to Inventory form at botton AO WASO Form - 177 ("R" June 1984) UNITED STATES DEPARTMENT OF THE INTERIOR NATIONAL PARK SERVICE NATIONAL REGISTER OF HISTORIC PLACES EVALUATION/RETURN SHEET Crocker. Ebenezer Sc., House (Barnstable MRA) _ ^ . ^ •o^.^mm Barnstable County MASSACHUSETTS Working No Fed. Reg. Date: JAN 2 T I98T n resubmission • nomination by person or local government • owner objection • appeal Substantive Review: • sample • request Date Due: ^V^a ^ 7 - jA/'^ Z^ 7 Action: ACCEPT ^ _fe^ETURN .^-/? -^7 REJECT Federal Agency: CU appeal R decision Reviewer's comments: Recom./Crite Reviewer Discipline Date pu^^ZA^Mpy . see continuation sheet Nomination returned for: technical corrections cited below .substantive reasons discussed below y^ 1. Name 2. Location 3. Classification Category Ownership Public Acquisition Status Accessible Present Use 4. Owner of Property 5. Location of Legal Description 6. Representation in Existing Surveys Has this property been determined eligible? • yes no 7. Description Condition excellent [m good • fair I I deteriorated I I ruins n unexposed Check one • unaltered n altered Describe the present and original (if known) physical appearance • summary paragraph [Zl completeness • clarity • alterations/integrity • dates I I boundary selection Check one • original site moved date. 8. Significance Period Areas of Significance—Check and justify below Specific dates Builder/Architect Statement of Significance (in one paragraph) • summary paragraph • completeness • clarity n applicable criteria n justification of areas checked CU relating significance to the resource • context CU relationship of integrity to significance CU justification of exception CD other •.i .-i '1 9. Major Bibliographical References 10. Geographical Data Acreage of nominated property Quadrangle name UTM References Verbal boundary description and justification 11. Form Prepared By 12. State Historic Preservation Officer Certification The evaluated significance of this property within the state is: national state local State Historic Preservation Officer signature title date 13. Other CD Maps CD Photographs • other Questions concerning this nomination may be directed to. Signed. Date 3/'S/&-) Phone: GPO 9 1 8-4S0 Comments for my item may be continued on ar? attached sheet FORM B - BUILDING MASSAGHOSETTS HISTCRICAL 00»!ISSI(»I 80 BOYLSTCW STREET BOSTON, MA 02116 Barnstable, Massachusetts MRA AREA FORM NO. CTB 41 •jXjun Barnstable (Cotuit-Cotuit Port) Address 49 Putnam Ave. Historic Name Ebenezer Crocker, Jr. House Photo (3"x3" or 3"x5", black and white) Indicate address of E^operty on back of photo. Staple to left side of form. Sketch Map: Draw map showing f^operty's location in relaticn to nearest cross streets and/or geographical features. Indicate all buildings between inventoried property and nearest intersection(s). Indicate north see attached assessors map Contributing/Non-contributing status 1 building C 4 structures C 2 structures NC Use: Present dwelling OrigincLl dwelling DESCRIPTION Date 1783- ca. 1920 Source Gilbert Crocker, style Style late Georgian Architect unknown Exterior Wall Fabric shingle CXltbuildings ice house/ wood shed, barn. workshop, cottage Major Alterations (with dates) porch added c. 1900 Condition excellent Moved no Date Acreage Setting 4.2 36/44 residential village area A [f^ls&OSZDNi^SSZO DIM REFERaJCE 6 \^ j58CXZ1C\^PcO&L'SO OSGS QOADRANGLE QnAuA'/'j HA lysDOd SCALE Recorded by Candace Jenkins Organization Barnguble Hifit.nrlr.fll Comin. Date 1986 NATIONAL REGISTER OOTERIA STATE»!ENT (if applicetole) The Ebenezer Crocker Jr. House possess integrity of location, design, setting, materials, workmanship, feeling and association. It is significant for its associations with the several illustrious families who have lived there: The Crockers, Hoopers and Lowells. It is also important for its associations with and continuous reflection of Cotuit's agricultural and summer resort history. Finally, it is significant as a fine piece of Georgian architecture enhanced by retention of its rural landscape and numerous outbuildings. The Crocker House thus meets criteria A, and C of the National Register of Historic Places. ARCHITECTURAL SIGNIFICANCE Describe important architectural features and evaluate in terms of other buildings within the ocHimunity. The Crocker House is a 2^ story gable roof structure with two interior chimneys. Its five bay facade is centered around the entry and a projecting enclosed porch at the second story. Windows at the first story have been replaced but the remainder are original and contain 6/6 sash; those on the side elevations have projecting lintels. The pilasters on the corners and the entry are similar to those of other Crocker family houses in Santuit (area CTA). There are two ells, one possibly older than the main house and a second, sail loft added with the summer kitchen before c. 1850-60. The porch on the south side and east was probably added in the 1860's by Gen. John Reed, the tenant who was allowed to make any changes he wanted. The window changes in the southwest parlor and the dining room (first story front) were made in 1892 by Mrs. Edward J. Lowell. The interior panelling is comparatively simple, though it is known that the northwest room had a panelled wall, which was so badly altered it was sealed up in 1892 and again in 1950. Except for narrowing the back hall to enlarge that room and altering the northeast bedroom to get a view and access HISTORICAL SIGNIFICANCE Explain the role owners played in local or state history and hew the (cont building relates to the development of the camunity. This house shows the further development of the houses built by the Crocker family in Santuit and the growth of interest in the maritime business. Ebenezer (1751-1817) married comparitively late and had his first son Nathan in 1783. It is possible that the house was built about that time as his grandson Gilbert stated and it was certainly there in 1794 when the road from Marstons Mills was completed to what is now Hooper's Landing. Ebenezer served two terms in the State legislature from 1791, which gave him the title of Esq. and Hon. and according to his gravestone was considered "an upright and efficient and useful citizen" as well as that "His conciliating manners and active benevolence greatly endeared him to the neighborhood in which he lived." He is said to have built the wharf, now represented by eelgrass near the west fence. His son Braddock added the store, later used as a boat house. The elder son, Nathan Crocker became the first episcopal bishop of Rhode Island and was one of the first of his family to move away. The estate was divided at Old Oyster Road and the western part of the land was not developed until recently. Braddock's daughter Mary Bourne Crocker married Alexander Scudder, ship captain. He was pursuaded to sell the estate to the Boston merchant Samuel Hooper, son-in-law to William Sturgis of Barnstable. This was to enable the captain to take one of the Hooper ships to the Gold Coast in 1849. Mr. Hooper became the first summer resident. Many well known people stayed in the house including Charles Sumner and other political figures. Hooper's niece Marian Hooper spent her honeymoon with Henry Adams in the house. Later, a cousin. Gen. John Reed rented the place with the privilege of making what changes he wished. After Mr. Hooper's death, Mrs. Edward J. Lowell took it over with her husband, historian of the French Revolution BIBLIOGRAHff and/or REFERENCES (cont.) Barnstable County Atlases. 18958, 1880, 1907. Santuit-Cotuit Historical Society. Cotuit Library. ** • INVENTORY FORM CONTINUATION SHEET MASSAaiUSETTS HISTORICAL CCM^SSION Office of the Secretary, Boston barnstable, Massachusetts MKA Community: Barnstable (Cotuit- Cotuit Port^ Form No: CTB 41 Property Nane: Ebenezer Crocker, Jr. House Indicate each item on inventoiy form which is being continued below. ARCHITECTURAL SIGNIFICANCE Continueii to the loft the house had had little change which could not be restored. Of extreme importance to the overall significance of the property, is its retention of numerous well-preserved outbuildings, making it one of the two best preserved farmsteads in the town. see detail below: HISTORICAL SIGNIFICANCE Continued and Hessians. Their daughter, Alice, wife of James Hardy Ropes, professor at Harvard took it over in 1904 and many academic visitors stayed there. Description: outbuildings Four contributing historic outbuildings, all of which date from the mid-19th century and all of which appear on the 1880 County Atlas, are scattered about the fields of the Ebenezer Crocker, Jr. House. The simplest is the post-1850 workshop which is a 1^ story shingled structure with no decorative detail. It retains early 6/6 sash, but has been modernized with an overhead garage door. It contained a forge in the 19th century. Of more interest is the cl850 ice house with attached woodshed. The ice house portion is a li story shingled structure whose gable roof is topped by a cupola. This center portion is framed by 1 story v/oodshed wings which retain original swinging doors. The largest and oldest outbuilding on the property is a cl794 barn which is a clapboarded gable roof struc- ture with cupola. Windows contain 6/6 sash and are headed by heavy caps. A carriage room was added later,during the ownership of Samuel Hooper. Finally, a board and batten cottage built cl850 by William Webb, a Scottish farmhand, exists on the property. It is a small story gable roof structure with a symmetrical three bay facade and lean-to roof pro- file. Two other outbuildings that are in deteriorated condition and appear to be later in date are not considered to be contributing, see attached photographs of all eutbuildings. Staple to Inventory form at bottom r— oo CO OJ Q_ CO A -^^^ _1 Ksr-jw-; 3£0 rc^ Scale 30^000. z y- (A .i>'y y>Ki-^ ..f'v • /• y,^=^^" '•yyy''z'<'^- OKIIISAXIMCIT |'C0TUITl^)Rl7-^ip: : -.r^ ' - :> H H • o 10 ^ 40 CO ' to »orod«// r^lj"W/2' j Scale zAooo. y .41 irtilfl, JS .^r V.H.I II, •rib /:i /t /i'f>^:. *\ ijil riuignrrtr.. \ " till • ^^^^gfAc^^y^^'^^^-y^^'^^z^^^Z'A'. J'^SD^Py=Z^}£yyyr^yZ'y y-^.; «1 jayl:i:^A>z^SAzy''" "^-'"'A^^A cphniurvj- • DVhujPijdit. y z\ • 1 JhrSOntny j S'lini!. yit/.er.wr/ A (yAATuiTM / • .-i'i"" ..' • • .y.'^ ' t Z 'Z- A ZZAAnoyA^ It .»It Afrf n ' - \ ."ir:. v-A'y 41 fah\arvi Ave 00 & NPS Form 10-900 a (781) United States Department of the Interior Nationai Park Service National Register of Historic Piaces inventory—Nomination Form Continuation sheet Item nunnljer For NPS iiss only received //^ 7A/ date entered Page Multiple Resource Area Thematic Group Name Barnstable MRA State Barn.qrahlp. Cnunfv. MA Nomination/Type of Review 31. Building at 600 Main Street Date/Signature 38. 39. 40. MwRBd iB -UM peeper peeper yzAy^^^^—Z^y.-^.^ -A 32. Building at 606 Main Street IwtwiDtd 1« t3to Attest •/iTeeper /ZfAcyt.^-^-^^y^'^^3-/3 7 33. Building at 614 Main Street ^^n,tj.uQ m tJiie Attest Z- Attest (Keeper ZZI^^^^-^^':?^--^ '• 34. Campbell, Collen C, House 35. Canary—Hartnett House /K eeper Attest itlT« HsvluyKeeper y/^/A^-'-^-^^i^'y^.^' 3 -/3 -S-/^ Attest Th^Tnil i« Vktt Z-^ 36. Chase, Lemuel B. , House , - /Keeper , y I'Zy 37. Codman, Col. Charles, Estate Attest S*itiintlTa Hevi^jKeeper Attest Crocker, Capt. Alexander, "^^^^^^ jjj House Crocker, Benomi and Barnabas, House Crocker, Ebenezer Jr., House Attest :!^^i!boMi Itsister la^«r»d In AAeeper XaUoaal a»«istor Attest _^ fcfaWtTe Hevl^^Keeper ^^J^i^ Attest AA>AA^^^-^rpqiy //llCfS WASO Form - 177 ("R" June 1984) UNITED STATES DEPARTMENT OF THE INTERIOR NATIONAL PARK SERVICE NATIONAL REGISTER OF HISTORIC PLACES EVALUATION/RETURN SHEET Crocker, Ebenezer Jr., House (Barnstable MRA) Barnstable County MASSACHUSETTS '~ \PAn%\i resubmission • nomination by person or local government im owner objection d appeal Substantive Review: [D sample Working No. Fed. Reg. Date: '^PJVl Date Due: ^ •///»/r/ Artion: ^\CCEPT //-/^ ''^'Z .RETURN. .REJECT. Federal Agency: • request appeal NR decision Reviewer's comments: c^y2z ^ -y^y^^j^'-u^ izrPa a^:i-^^e^'=f^ cZ. Recom./Criter, Reviewer. Discipline Date ^^^^^ uation sheet Nomination returned for: .technical corrertions cited below .substantive reasons discussed below 1. Name 2. Location 3. Classification Category Ownership Public Acquisition Status Accessible Present Use 4. Owner of Property 5. Location of Legal Description 6. Representation in Existing Surveys Has this property been determined eligible? • yes • no 7. Description Condition excellent im good • fair I I deteriorated [~~1 ruins I I unexposed Check one unaltered altered Describe the present and original (if known) physical appearance • summary paragraph . : ' , • completeness • clarity • alterations/integrity • dates I I boundary selection Cheek one • original site nraved date. 8. Significance Period Areas of Significance—Check and justify below Specific dates Builder/Architert Statement of Significance (in one paragraph) • summary paragraph ~ "••Trrr.r-" T'„^^".V-" CU completeness r.-7,r:;=r^.^yrT'r-- ,-^^7rr • clarity • applicable criteria • justification of areas checked ' " O relating significance to the resource ' O context ' ^: . ' •• CU relationship of integrity to significance ' . CU justification of exception CU other 9. Major Bibliographical References 10. Geographical Data Acreage of nominated property Quadrangle name UTM References Verbal boundary description and justification 11. Form Prepared By 12. State Historic Preservation Officer Certification The evaluated significance of this property within the state is: national state local State Historic Preservation Officer signature title data 13. Other CU Maps CU Photographs • other Questions concerning this nomination may be directed to. Signed Date Phone: GPO 91 8-450 Comments for my item may be continued on an attached sheet " BArnstable, MA MRA Ebenezer Crocker, Jr. House 49 Putnam Ave., Cotuit Assessors' Map SEP ^ 8 198T Please refer to the map in the Multiple Property Cover Sheet for this property Multiple Property Cover Sheet Reference Number: 64000271 April 17, 2025 Ben Haley National Register Director Massachusetts Historical Commission 220 Morrissey Blvd. Boston, MA 02125 Dear Mr. Haley; According to 36 CFR 60.14 (b), Relocating properties listed in the National Register, when a building listed in the register is proposed to be moved it must go through the required review and approval procedures for National Register nominations. Procedures for Move and New Location: The Ebenezer Crocker Jr. House (NRIS ##87000323) presently located at 49 Putnam Ave is being relocated to an adjacent property 59 Putnam Ave. These lots were originally one lot which was subdivided at a later date. See included site plan(s). The current house is located at Lot “A” and we are proposing to move the house to “building” location on Lot “F”. The proposed location is at the site of the original barn which was demolished in cooperation with the Town of Barnstable in 2017 due to disrepair and safety concerns prior to the current ownership. We are proposing to move the original house without the later ell additions. We would be recommending to bring the structure back to it’s original state. This will be consistent with the Form “B” of the listing for the Ebenezer Crocker Jr House c. 1783 and consistent with the original property. The ell additions are believed to be added in the 1850’s and are not part of the original house or the NRIS listing. The proposed site is a location that is more visible. It is in an adjacent grassy field and will add to the visibility of he property without diminishing the historic relevance as it was originally a single property. The barn was removed in 2017 in cooperation with the Town of Cotuit. The stone walls of the barn were left and would be repurposed as part of the new foundation. The structure would be relocated by a reputable house moving company Gary Sylvester, Gary Sylvester Building Movers and Excavators. This company had been in business for more than 60 years. They were founded by John Sylvester in East Falmouth in 1954 and are one of the most prominent house moving companies on Cape Cod. Before proposing this move we consulted about the feasibility of relocating the existing structure and were informed that it is indeed possible. There has been remedial repairs done throughout the years including a renovation in 2002. This has kept the framing of the existing house in good condition and aids in the stability of the structure. Reason for the Move: The move of the structure is being proposed to create a better connection between the owners existing home on an adjacent property and the outdoor living space. This move will create a better visibility for The Ebenezer Crocker Jr house in the Town making it a more prominent landmark. The current house location is not visible from the street. It is located on a turn and shrouded by trees. The new location is an adjacent grassy field of the same original property where the structure of the original barn once stood. PO Box 6326. Plymouth, MA 02362 . info@archiplicity.com . 508.789.7184 Appropriateness of the New Setting: The new site is adjacent to the existing house location. The property was originally one property and was divided at a later date into separate lots. The move of the house will have no affect on the historical significance of the property as it was originally a singular property. The move is wholly appropriate as the current building location and the proposed were originally the same property. The visibility in the field adds to the visibility of the property as a whole. Effects of the move on the Structure: The move and the new location will have no effect on the historical the integrity of the structure. When consulting the house mover regarding the relocation we were informed that the structure was in good condition and was able to be relocated. Effects of the move on the Archeological or Historic Resources at New Location: The new location is on what was the original property and therefore there is no effect to the archeological significance. We are maintaining the same original homestead in the relocation. Impact on Historic Significance: The Ebenezer Crocker Jr. House will continue to be located on the original property which was historically one and will remain adjacent to the buildings in the original listing ( The Ropes Ice House c 1851 and the Ropes Workshop c. 1855). There is therefore no impact as the listing will remain constituent to the current listing with the joined properties. The building will be moved and relocated on a concrete foundation. We will repurpose stones from the original barn as part of the new foundation. In this regard the building shall still be considered eligible for retaining its National Register Historic status. Please find attached photos, site plan(s)of the current, historic and proposed property locations, and a photographic overview of the relocation. Please feel free to contact me with any questions at 508-789-7184 or jen@archiplicity.com. Thank you for your consideration. Sincerely; Jennifer L. Birnstiel Principal, Archiplicity, LLC Enc. Site Plan, Photos, Application Attached Overview of Location & Relocation - Google Earth/Photos PO Box 6326. Plymouth, MA 02362 . info@archiplicity.com . 508.789.7184 Site Plan: PO Box 6326. Plymouth, MA 02362 . info@archiplicity.com . 508.789.7184 PO Box 6326. Plymouth, MA 02362 . info@archiplicity.com . 508.789.7184 Photos of Existing Location: View of Original Location at 49 Putnam Ave: PO Box 6326. Plymouth, MA 02362 . info@archiplicity.com . 508.789.7184 View of Original House from Driveway PO Box 6326. Plymouth, MA 02362 . info@archiplicity.com . 508.789.7184 Photos of Proposed Location: View of Proposed Location from Putnam Ave PO Box 6326. Plymouth, MA 02362 . info@archiplicity.com . 508.789.7184 View Original Stone Foundation - Barn PO Box 6326. Plymouth, MA 02362 . info@archiplicity.com . 508.789.7184 NPS Form 10900 OMB Control No. 10240018 expiration date 03/31/2026 United States Department of the Interior National Park Service National Register of Historic Places Registration Form This form is for use in nominating or requesting determinations for individual properties and districts. See instructions in National Register Bulletin, How to Complete the National Register of Historic Places Registration Form. If any item does not apply to the property being documented, enter "N/A" for "not applicable." For functions, architectural classification, materials, and areas of significance, enter only categories and subcategories from the instructions. 1.Name of Property Historic name: Ebenezer Crocker Jr. House __________________________________________ Other names/site number: ______________________________________ Name of related multiple property listing: _______Ropes Ice House, Ropes Workshop , Barn (demolished 2017) ____________________________________________________ (Enter "N/A" if property is not part of a multiple property listing ____________________________________________________________________________ 2.Location Street & number: _________49 Putnam Ave____________________________________ City or town: _____Barnstable (Cotuit)_______ State: _______MA_____ County: ______Barnstable______ Not For Publication: Vicinity: ____________________________________________________________________________ 3.State/Federal Agency Certification As the designated authority under the National Historic Preservation Act, as amended, I hereby certify that this x nomination ___ request for determination of eligibility meets the documentation standards for registering properties in the National Register of Historic Places and meets the procedural and professional requirements set forth in 36 CFR Part 60. In my opinion, the property __x_ meets ___ does not meet the National Register Criteria. I recommend that this property be considered significant at the following level(s) of significance: ___national ___statewide __x_local Applicable National Register Criteria: __x_A _x__B _x__C ___D Signature of certifying official/Title: Date ______________________________________________ State or Federal agency/bureau or Tribal Government 1 United States Department of the Interior National Park Service / National Register of Historic Places Registration Form NPS Form 10900 OMB Control No. 10240018 Name of Property County and State ______________________________________________________________________________ 4.National Park Service Certification I hereby certify that this property is: x entered in the National Register determined eligible for the National Register determined not eligible for the National Register removed from the National Register other (explain:) _____________________ ______________________________________________________________________ Signature of the Keeper Date of Action ____________________________________________________________________________ 5.Classification Ownership of Property (Check as many boxes as apply.) Private: Public – Local Public – State Public – Federal Category of Property In my opinion, the property x meets does not meet the National Register criteria. Signature of commenting official: Date Title : State or Federal agency/bureau or Tribal Government Sections 1-6 page 2 X United States Department of the Interior National Park Service / National Register of Historic Places Registration Form NPS Form 10900 OMB Control No. 10240018 Name of Property County and State (Check only one box.) Building(s) District Site Structure Object Number of Resources within Property (Do not include previously listed resources in the count) Contributing Noncontributing _______3______ _____________ buildings _____________ _____________ sites _____________ _____________ structures _____________ _____________ objects _____________ ______________ Total Number of contributing resources previously listed in the National Register _________ ____________________________________________________________________________ 6.Function or Use Historic Functions (Enter categories from instructions.) ___________________ ___________________ Sections 1-6 page 3 X United States Department of the Interior National Park Service / National Register of Historic Places Registration Form NPS Form 10900 OMB Control No. 10240018 Name of Property County and State _Domestic - Single Dwelling ___________________ ___________________ ___________________ Current Functions (Enter categories from instructions.) ___Private Residence__ ___________________ ___________________ ___________________ _____________________________________________________________________________ 7.Description Architectural Classification (Enter categories from instructions.) ____Late Georgian______ ___________________ ___________________ ___________________ ___________________ ___________________ ___________________ Materials: (enter categories from instructions.) Principal exterior materials of the property: ___Shingle_____________________ Sections 1-6 page 4 United States Department of the Interior National Park Service / National Register of Historic Places Registration Form NPS Form 10900 OMB Control No. 10240018 Name of Property County and State Narrative Description (Describe the historic and current physical appearance and condition of the property. Describe contributing and noncontributing resources if applicable. Begin with a summary paragraph that briefly describes the general characteristics of the property, such as its location, type, style, method of construction, setting, size, and significant features. Indicate whether the property has historic integrity.) ______________________________________________________________________________ Summary Paragraph The previously listed Ebenezer Crocker Jr. House ((NRIS ##87000323) located on 49 Putnam Ave in Cotuit, Massachusetts is being proposed to be move to an adjacent location at 59 Putnam Ave an adjacent lot and part of the original homestead. A narrative of the new location and proposed move are listed below ______________________________________________________________________________ Narrative Description SETTING: The Ebenezer Crocker Jr. House c. 1783 (NRIS ##87000323) presently located at 49 Putnam Ave is being moved to the adjacent property 59 Putnam Ave. These lots were originally one lot which was subdivided at a later date.. See included site plan. The current house is located at Lot “A” and we are proposing to move it to the “building” location on Lot “F”. The Proposed location is at the site of the original barn which was demolished in cooperation with the Town of Barnstable in 2017 because of disrepair and safety concerns. The proposed location is at a spot that is more visible location in a grassy field and will maintain the significance of the listing without diminishing the historic relevance as it was at onetime a single property. BUILDING: We would be moving the original house without the later added ell additions. We would be recommending to bring the structure back to it’s original state. This will be consistent with the Form “B” of the listing for the Ebenezer Crocker Jr House c. 1783 and consistent with the original property. The additions are believed to be added in the 1850’s and are not part of the original house or the the listing. The stone walls of the barn were left and would be repurposed as part of the new foundation. Sections 1-6 page 5 _________________________________________________________________ 8.Statement of Significance Applicable National Register Criteria (Mark "x" in one or more boxes for the criteria qualifying the property for National Register listing.) A.Property is associated with events that have made a significant contribution to the broad patterns of our history. B.Property is associated with the lives of persons significant in our past. C.Property embodies the distinctive characteristics of a type, period, or method of construction or represents the work of a master, or possesses high artistic values, or represents a significant and distinguishable entity whose components lack individual distinction. D.Property has yielded, or is likely to yield, information important in prehistory or history. Criteria Considerations (Mark “x” in all the boxes that apply.) A.Owned by a religious institution or used for religious purposes B.Removed from its original location C.A birthplace or grave D.A cemetery E.A reconstructed building, object, or structure F.A commemorative property G.Less than 50 years old or achieving significance within the past 50 years Section 8 page 6 X X X Areas of Significance (Enter categories from instructions.) Entertainment/Recreation__ _____Agriculture___ ____Architecture_______ ___________________ ___________________ ___________________ ___________________ Period of Significance __1900-1924.__1875-1899, 1850-1874___ __1825-1849, 1800-1824, 1750-1799_________________ ___________________ Significant Dates ___________________ ___________________ ___________________ Significant Person (Complete only if Criterion B is marked above.) Ebenezer Crocker Jr______________ ___________________ ___________________ Cultural Affiliation ___________________ ___________________ ___________________ Architect/Builder ______Unknown_________ ___________________ ___________________ Section 8 page 7 Statement of Significance Summary Paragraph (Provide a summary paragraph that includes level of significance, applicable criteria, justification for the period of significance, and any applicable criteria considerations.) ______________________________________________________________________________ Narrative Statement of Significance (Provide at least one paragraph for each area of significance.) Section 8 page 8 ______________________________________________________________________________ 9.Major Bibliographical References Bibliography (Cite the books, articles, and other sources used in preparing this form.) ___________________________________________________________________________ Previous documentation on file (NPS): ____ preliminary determination of individual listing (36 CFR 67) has been requested __x__ previously listed in the National Register ____ previously determined eligible by the National Register ____ designated a National Historic Landmark ____ recorded by Historic American Buildings Survey #____________ ____ recorded by Historic American Engineering Record # __________ ____ recorded by Historic American Landscape Survey # ___________ Primary location of additional data: __x__ State Historic Preservation Office ____ Other State agency ____ Federal agency ___x_ Local government ____ University ____ Other Name of repository: _____________________________________ Historic Resources Survey Number (if assigned): ________________ ______________________________________________________________________________ 10.Geographical Data Acreage of Property ____2.79 acres___________ Sections 9-end page 9 Use either the UTM system or latitude/longitude coordinates Latitude/Longitude Coordinates Datum if other than WGS84:__________ (enter coordinates to 6 decimal places) 1.Latitude: 41.623197 Longitude:-70.432872 2.Latitude: Longitude: 3.Latitude: Longitude: 4.Latitude: Longitude: Or UTM References Datum (indicated on USGS map): NAD 1927 or NAD 1983 1.Zone: Easting: Northing: 2.Zone: Easting: Northing: 3.Zone: Easting: Northing: 4.Zone: Easting : Northing: Verbal Boundary Description (Describe the boundaries of the property.) Sections 9-end page 10 Boundary Justification (Explain why the boundaries were selected.) ______________________________________________________________________________ 11.Form Prepared By name/title: Jennifer Birnstiel_______________________________________________ organization: Archiplicity, LLC ________________________________________________________ street & number: PO Box 6326_________________________________________________ city or town: ____Plymouth___________ state: __MA__________ zip code:_02362 __________ e-mail___jen@archiplicity.com_____________________________ telephone:_______508-789-7184__________________ date:____________4/17/25_________________ ___________________________________________________________________________ Additional Documentation Submit the following items with the completed form: •Maps: A USGS map or equivalent (7.5 or 15 minute series) indicating the property's location. • Sketch map for historic districts and properties having large acreage or numerous resources. Key all photographs to this map. •Additional items: (Check with the SHPO, TPO, or FPO for any additional items.) Sections 9-end page 11 Sections 9-end page 12 Photographs Sections 9-end page 13 Submit clear and descriptive photographs. The size of each image must be 1600x1200 pixels (minimum), 3000x2000 preferred, at 300 ppi (pixels per inch) or larger. Key all photographs to the sketch map. Each photograph must be numbered and that number must correspond to the photograph number on the photo log. For simplicity, the name of the photographer, photo date, etc. may be listed once on the photograph log and doesn’t need to be labeled on every photograph. Photo Log Name of Property: Ebenezer Crocker Jr. House City or Vicinity: Cotuit (Barnstable) County: Barnstable State: MA Sections 9-end page 14 Photographer: Jennifer Birnstiel Date Photographed: Description of Photograph(s) and number, include description of view indicating direction of camera: 1 of ___4. Paperwork Reduction Act Statement: This information is being collected for nominations to the National Register of Historic Places to nominate properties for listing or determine eligibility for listing, to list properties, and to amend existing listings. Response to this request is required to obtain a benefit in accordance with the National Historic Preservation Act, as amended (16 U.S.C.460 et seq.). We may not conduct or sponsor and you are not required to respond to a collection of information unless it displays a currently valid OMB control number. Estimated Burden Statement: Public reporting burden for each response using this form is estimated to be between the Tier 1 and Tier 4 levels with the estimate of the time for each tier as follows: Tier 1 – 60-100 hours Tier 2 – 120 hours Tier 3 – 230 hours Tier 4 – 280 hours The above estimates include time for reviewing instructions, gathering and maintaining data, and preparing and transmitting nominations. Send comments regarding these estimates or any other aspect of the requirement(s) to the Service Information Collection Clearance Officer, National Park Service, 1201 Oakridge Drive Fort Collins, CO 80525.Original Home Location - Sections 9-end page 15 Original House location - South East - 49 Putnam Ave Lot ”A” Sections 9-end page 16 Original House Location - 49 Putnam Ave, Cotuit (Barnstable) South East - Lot “A” Sections 9-end page 17 Proposed House location - Original Barn location - Lot “F” Sections 9-end page 18 Original Barn Location - Lot “F” Sections 9-end page 19 Cotuit, MAHISTORICHOMERELOCATION02635-282149 Putnam Ave1NO.DESCRIPTION BY DATE Jennifer BirnstielPO Box 6326Plymouth MA 02362508.789.7184info@archiplicity.comArchiPlicity, llc.AERIAL VIEWSTREET VIEWSTREET VIEWSTREET VIEW HYANNIS, MA 02601 035072 BARNSTABLE, TOWN OF (LDG) 367 MAIN STREET Property ID: COTUIT, MA 02635 035105 MOORE, PATRICIA 33 PUTNAM AV Property ID: PO BOX 89 COTUIT, MA 02635 035106 GEYSER, CONRAD ARLEN TR GEYSER REVOCABLE TRUST Property ID: PO BOX 497 COTUIT, MA 02635 036035 KORNBLUM, MARGARET R TR R J KORNBLUM 2010 TR & M R KORNBLUM Property ID: WEST BARNSTABLE, MA 02668 036036 BARNSTABLE LAND TRUST INC 1540 MAIN STREET Property ID: 86 PUTNAM AVENUE COTUIT, MA 02635 036037 ZAIS, CAROL D & ADAM S TRS CAROL D ZAIS 2017 TRUST Property ID: 9002 DOUGLAS AVENUE DALLAS, TX 75225 036041 POPOLO, JOSEPH VICTOR JR TR COTUIT BAY TRUST Property ID: 9002 DOUGLAS AVENUE DALLAS, TX 75225 036041001 POPOLO, JOSEPH VICTOR JR COTUIT BAY TRUST Property ID: DALLAS, TX 75219 036041002 COLLINS, SHANNON 3510 TURTLE CREED BLVD APT 10C Property ID: COTUIT, MA 02635 036043 ANGELO, RICHARD J JR 15 PUTNAM AVENUE Property ID: 9002 DOUGLAS AVENUE DALLAS, TX 75225 036044001 POPOLO, JOSEPH VICTOR JR TR COTUIT BAY TRUST Property ID: P O BOX 1605 COTUIT, MA 02635 036044002 ASSOCIATION OF THE COTUIT MOSQUITO YACHT CLUB INC Property ID: DALLAS, TX 75219 036045 COLLINS, SHANNON 3510 TURTLE CREEK BLVD APT 10C Property ID: COTUIT, MA 02635 036050 MOORE, PATRICIA L ESTATE OF 33 PUTNAM AVENUE Property ID: 756 MAIN STREET COTUIT, MA 02635 036059 JONES, KEVIN EUGENE & MARY CATHERINE KEVIN JONES & MARY JONES TRUST Property ID: COTUIT, MA 02635 036060 MOORE, NICHOLAS C 33 PUTNAM AVE Property ID: