HomeMy WebLinkAbout2400 MAIN STREET �. ;�� Q
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Application number ., . y ......../... ... .....
Fee . ............................... ... .......................
LARNST"
M �' Eg 8 ) Building Inspectors Initials............ .... .. .- .........
�' 01,
r 1AM 0 1 bA`� I
i HNSI- ABLE Date Issued................zlvt .C�. ...................................
22 ��ll �
Map/Parcel...........!� V�
TOWN OF BARNSTABLE
EXPEDITED PERMIT APPLICATION:
ROOF/SIDING/WINDOWS/DOORS/TENTS/STOVES/WEATHERIZATION
PROPERTY INFORMATION
Address of Project: ��� ����
NUMBER STREET VILLAGE
Owner's Name: Jl����jdl�/e Je Ve Phone Number 6 17
Email Addres, � t d C ® Cell Phone Number
Project cost $ rr'{�� 8y _ -_ Check one Residential Commercial
OWNER'S AUTHORIZATION
As owner of the above property I hereby authorize
to make application for a building permit in accordance with 780 CMR
Owner Signature: Date:
TYPE OF WORK
❑ Siding ❑ Windows (no header change) # ❑ Insulation/Weatherization
❑ Doors (no header change) # Commercial Doors require an inspector's review
Roof(not applying more than 1 layer of shingles)
Construction Debris will be going to AA 4
CONTRACTOR'S INFORMATION
Contractor's name ,� z.c �- tt cl- 5 « S
Home Improvement Contractors Registration (if applicable) 3 jj` (attach copy)
Construction Supervisor's License # CS 1a8 `S 7 (attach copy)
Email of Contractor G eG �Z� �l t CGS Phone number 7 7
ALL PROPERTIES THAT HAVE STRUCTURES OVER 75 YEARS OLD OR IF THE SUBJECT PROPERTY IS IN
A HISTORIC DISTRICT, YOU MUST OBTAIN HISTORIC APPROVAL BEFORE A PERMIT CAN BE ISSUED.
APPLICATION NUMBER ............................................................
*For 'Tents Only*
Date Tent (s) will be erected Removed on number of tents total
Does the tent have sides? Yes No (If yes please attach floor plan with exits marked)
Dimensions of each Tent X X I X
Additional tent dimensions can be attached on a separate piece of paper.
Purpose of Event
Check one: this event is a: for profit non-profit event
Check one: Food served Yes No
Flame Spread Sheet of each tent must be attached. Provide a site plan with the location (s) of each tent
If food is being served at your event please obtain a Health Department approval between the hours
of 8:00am -9:30 am or 3:30 pm-4:30pm. Commercial events may require Fire Department approval.
*WOOD/COAL/PELLET STOVES
Manufacturer# Model/I.D.
Fuel Type Testing Lab
Offsets from combustibles: front back left side right side
HOMEOWNER'S LICENSE EXEMPTION
Homeowner's Name:
Telephone Number Cell or Work number
I understand my responsibilities under the rules and regulations for Licensed Construction
Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand
the construction inspection procedures, specific inspections and documentation required by 780
CMR and the Town of Barnstable.
Signature Date
APPLICANT'S SIGNATURE
Signature Date r l
All permit applications are subject to a building official's approval prior to issuance.
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Offi-e of Cof3siumel`Affairs and Business Regu.?:n�i:Isfl"i
1000 Washington trees `uii'te 710
Boston, 11fIaS-a-DC;iLiseiis 02118
Home 1rr provem_b> ,F,.'
an-trador;Sc-gisk`I atiori
Type; Corporation
Registration: 103714
PAUL J. CAZEAUL i 8 SONS, INC.
1031 MAIN STREET Expiration: 07/00/2020
OS T ERVILLE,MA 02655
Update Address and Ref Irn Card.
SC,A 1 Ca 20ki-05!17
:���ie (�Oli?/.r10iNCL'r�>/,O�,.G'Uf.%IJCGeYIrIJf'l.✓
Orrice ofConsumerA airs$Business Regulation
HOME IIJ1!'ROVEMEN T CON T RAC T Or Recgistratron valid for hidividuai use emy
TYP Corporation Before the expiration date. Ir Tound return 3o;
peQlWii 'lOri Expiration :Jii'ice oe GQrsulner f o"laii'S cl9d QuS,inass Pegulattion
t03:714.= D7/OSl2020 140a Wasf�ing@on Street•Suite 710
T.ri SONS-i, Boston,MA 02118
RUSSELLCAZEAULT-:.';,_ ..'`' ° --
1031 MAIN STREET;:..`;
OSTEP.VILLE,MA 02655 Nc't Mid b11 1:1—Al sign a
h a'ui
Undersecretary �-
s
Tall-tree In IW :(800)698-556.0
Qsterv€lle:(508)428-1177 Odeails:(508)255-5559 hpf11ouffi:(508)457-1 141 Fax:(5618)420-4555 �
1
Bop.'017,MA �MT j�`,20 7 7
-pi, Y,a 9 S. vlar 4.
1-170 vs, com.p en,s 2,t`on i-A su a nce AlMy d a v i B ii 5ders/Co P-at vac tors/Ef i ectrik"i zns/F 1,;�i inbers
TO BEF,71,EIT)°,.1,7,TH
.7_nfo:mnt;en
Namp, (Bvsiness/orcanization/i ridIvidual): f I
A_
Li y/stat&Z_1): "Ph, r
OIL 0ieck the�.,V,alupriatc y �Ype DF r J1 i
-,a 113 a employer with ez;�fialj a id/01,—enu)oye Nev.,construction
I arria sole propietcr or parblers-iii)and have no employees i-vorking for ine.Jr.. aerno delinE
Lj
any capacity.fNo workers!conip-insurance required.]
i 3.❑1 arri a homeowner doin.-ail worl,myself(No workers'comp.insurance required.]t Demolition
4 1 ama hoineownerand will behin'ng contractors to conduct all wonk on my properly. 1 will 10 El Building addition
ensure that all contractors either have workers'compensation insurance or are sole 11.r_j Electrical repairs or additions
proprietors with no employees.
12.
5.f—]j an-a a general contractor and I havo hued the sub-contractors listed on the attached sheet. F]Plumbing repairs or additions
These sob-contractors have ernp[o-e��s and have worKers'comp.insuranxe_' 13.El Roof repairs
6.F]We are a corporation and its office-s have exercised their right of exemption.per 1MGL c,
lA,D Other 13Z
152,j 1(4),and we have no employees.[No workers'comp,insurance required.]
*Any applicant that checks box-,I must also fill out the section belov,,showing their workers'compensation policy information.Homeowners who submit this affidavit I�ndicatiia they are doin!z all work and then hi-re outside contractors must submit a new affidavit indicating such.
lcontractoTs that check this box must attached On additional sheet showing the name of the sub-contractors and state whether or not these entities have
employees. If the sub-contractors have employes,they MUSt provide their workers'comp.P01 icy TILArnber.
Below is the policy and job site
inforination.
Insurance Company-Name:
- 12
V
Policy"'or Self-ins.Lic,ff: V I _. ,--- 5 S _D j zf ✓�(j Expiration Date: Sh
Job Site Address: YOO IV//-/4/ rl / City1State1ZZiP:_iVjAA1Y lk#54
Attach acopy of the workers'compensation policy declaration age(sihowting the policy number and expiration date�-page
Failure to secure coverage as required.under IMGT c. 152,§25A is a criminal violation punishableby 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.A copy of-this statement may be forwarded to the Office of[Investigations of the DLk for insurance
coverage verification.
1(10 he] hY j-o
cerlifj)finde r thepain x s idpen cif'altles perjitry thattlie i'itlo;�iizatioiil) vic,(,d w and above is oe corrae
S naturg: Date:
Phone 1-1":
Ofjicial rise on.1j). Do not lwite in t.Ws area, to be completed by city oi-town.Of'zcial.
City or Town: Perinit/License
Issuing Authority(circle one):
I. Board of Health 2.Building Department 3.City/Town Clerk 4.Eleerrical-Trispector S.Piumbhug Inspector
6. Other
Contact Person: Phone
DATE(MM/DD/YYYY)
CERTIFICATE OF LIABILITY INSURANCE 11/07/2018
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to
the terms and conditions of the policy; certain policies may require an endorsement. A statement on this certificate does not confer rights to the
certificate holder in lieu of such endorsement(s).
PRODUCER CONTACT
NAME: Linda Sullivan
AX
ON
DOWLING & O'NEIL INSURANCE AGENCY PHC.N. Ext: (508)775-1620 FA/c.No:
ADDRESS: Iullivan@doins.com
973 IYANNOUGH RD INSURER(S)AFFORDING COVERAGE NAIC#
HYANNIS MA 02601 INSURER A: LM INS CORP 33600
INSURED
INSURER B
PAUL J CAZEAULT& SONS INC INSURER C:
INSURER D:
1031 MAIN ST INSURER E:
OSTERVILLE MA 02655 INSURER F:
COVERAGES CERTIFICATE NUMBER: 334821 REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
ILTR TYPE OF INSURANCE ADDL SUER POLICY NUMBER MM/DDY/YYYY MM/DD/YYYY LIMITS
COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $
CLAIMS-MADE OCCUR DAMAGE (RENTED
PREMISES Ea occurrence) $
MED EXP(Any one person) $
N/A PERSONAL&ADV INJURY $
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $
POLICY❑JECT PRO ❑LOC PRODUCTS-COMP/OP AGG S
OTHER: $
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $
Ea accident
ANY AUTO BODILY INJURY(Per person)
ALL OWNED SCHEDULED
AUTOS AUTOS NIA BODILY INJURY(Per accident) $
NON-OWNED PROPERTY DAMAGE $
HIRED AUTOS AUTOS Per accident
$
UMBRELLA LIAB OCCUR EACH OCCURRENCE S
EXCESS LIAR CLAIMS-MADE N/A AGGREGATE S
DED I I RETENTION$ $
WORKERS COMPENSATION X STATUTE OERH
AND EMPLOYERS'LIABILITY
ANYPROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT S 1,000,000
A OFFICERIMEMBEREXCLUDED? NIA N/A NIA WC531S386670028 08/10/2018 08/10/2019
(Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000
If yes,describe under
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S 1,000,000
N/A
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,maybe attached if more space is required)
Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay
claims for benefits to employees in states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts.
This certificate of insurance shows the policy in force on the date that this certificate was issued(unless the expiration date on the above policy precedes the
issue date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification
Search tool at www.mass.gov/lwd/workers-corrpensation/investigations/.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
Great Quality General Contracting Inc
1099 Main Street
AUTHORIZED REPRESENTATIVE
Marshfield MA 02050 L
Daniel M.Cro 'ey,CPCU,Vice President—Residual Market—WCRIBMA
@ 1988-2014 ACORD CORPORATION. All rights reserved.
ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD
f -
PAUL J.
& SONS
Property Owner Must Complete & Sign This Form
If Using a Roofer / Builder
I(print) I�e-k nce- 0-e ye--; 6!1 S , as Owner / Agent
of the subject property hereby authorize Paul J Cazeault & Sons, Inc to act on
my behalf in all matters relative to work authorized by this building permit
application for:
Address of Job c'�4 D® (K1GuYq :5�. & Gam&+-a - U- (Y)6( aZ 6 G,
Signature of Ownerpkii-6 Ica
Mailing Address of Owner `7S- r LH a M (E�k- (A-�aJ-Cry rjJr-)
Telephone # Or
i 1 I I I
Date 1 ' 'Z 1 - IQ
Please return this form to Paul J Cazeault& Sons, Inc along with your signed contract.
It is needed for us to obtain the building permit required by your town to complete your roofing project
FAX—508-420-4555
EMAIL—office@cazeault.com
Town of Barnstable Buildin
r -We Post ThiT,17
s CarddSo That�t rs;Ursible Fromthe StreetApproved Plans Must�be Re#arned on Job�and this Card,Musi be:Kept �.. , 9
,,
M,ya: Posted Until�Final'InspectionsHas�Been Nllade ��;
a:g�¢R rWhere;a Certificate>of Occu .anc.''%Is'Re wired such°Buildin shallNot be-Occu d until aFinalIns action hasbeen made Permit
ie
Permit No. B-16-3632 Applicant Name: Russell Cazeault Approvals
Date Issued: 03/09/2017 Current Use: Structure
Permit Type: Building-Siding/Windows/Roof/Doors Expiration Date: 09/09/2017 Foundation:
Location: 2400 MAIN ST./RTE 6A(BARN.),BARNSTABLE Map/Lot 237 0255 Zoning District: SPLIT Sheathing:
Owner on Record: HAYES,SUSAN BASSETT � f Contractor Name PAULJ.CAZEAULT&SONS, Framing: 1
Address: 2400 MAIN ST./RTE 6A b =x INC. 2
�i
WEST BARNSTABLE, MA 02668 Contractor License 103714
Chimney:
Description: Remove existing cedar roof on the front of thelmain house and the Est Protect Cost: $ 12,600.00
Insulation:
rear of the home. Install new roof in GAF HD afthltectural asphalt P..ermit Fee: $64.26
shingles in Weathered Wood. (approved historical color) ' Final:
OL ee Paid: $64.26
Project Review Req: Remove existing cedar roof on the front of the main House"and , Date: 3/9/2017
the rear of the home. Install new roof in,GAF HD architectural `� � £ ° Plumbing/Gas
asphalt shingles in Weathered Wood. (approvedihistorical R
-- wl
Rough Plumbing:
color).
y r3 4 Final Plumbing:
!BuildingOfficial
7�
A Rough Gas:
This permit shall be deemed abandoned and invalid unless the work authonzed by this permit is commenced within six months after issuance.
All work authorized by this permit shall conform to the approved application heapproved construction documents for which this permit has been granted. Final Gas:
All construction,alterations and changes of use of any building and structures shalljbe in compliance with the local zoning by laws and codes.
This permit shall be displayed in a location clearly visible from access streetorraad and shall be maintained open for public mspectian for the entire duration of the
completion of the same.
Electrical
work until the coin
P A
a �. $ sin.
F � Service:
The Certificate of Occupancy will not be issued until all applicable signatures by the 8wlding and Fire Officials acre prouded ontFiis permit.
Minimum of Five Call Inspections Required for All Construction Work: p Rough:
1.Foundation or Footing
2.Sheathing Inspection Final:
3.All Fireplaces must be inspected at the throat level before firest flue lining is installed
4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Low Voltage Rough:
5.Prior to Covering Structural Members(Frame Inspection)
6.Insulation Low Voltage Final:
7.Final Inspection before Occupancy
Health
Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Final:
Work shall not proceed until the Inspector has approved the various stages of construction.
"Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Fire Department
Final:
Building plans are to be available on site
All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT
Town of Barnstable RECEI�T]
"8tF 200 Main Street, Hyannis MA 02601 508-862-4038
Application for Building Permit
Application No: TB-16-3632 Date Recieved: 12/9/2016
Job Location: 2400 MAIN ST./RTE 6A(BARN.),BARNSTABLE
Permit For: Building-Siding/Windows/Roof/Doors
Contractor's Name: PAUL J. CAZEAULT&SONS, INC. State Lic. No: 103714
Address: 1031 MAIN ST, OSTERVILLE, MA 02658 Applicant Phone: (508)428-1177
(Home)Owner's Name: HAYES,SUSAN BASSETT Phone: (617)901-1180
(Home)Owner's Address: 2400 MAIN ST./RTE 6A, WEST BARNSTABLE,MA 02668
Work Description: Remove existing cedar roof on the front of the main house and the rear of the home.Install new roof in GAF
HD architectural asphalt shingles in Weathered Wood.(approved historical color).
Total Value Of Work To Be Performed: $12,600.00
Structure Size: 0.00 0.00 0.00
Width Depth Total Area
I hereby.swear and attest that I will require proof of workers'compensation insurance for every contractor,subcontractor,or other worker before
he/she engages in work on the above property in accordance with the Workers' Compensation Act(Chapter 568).
I understand that pursuant to 31-275 C.G.S.,officers of a corporation and partners in a partnership may elect to be excluded from coverage by filing a
waiver with the appropriate District Office;and that a sole proprietor of a business is not required to have coverage unless he files his intent to accept
coverage.
I hereby certify that I am the owner of the property which is the subject of this application or the authorized agent of the property owner and have
been authorized to make this application. I understand that when a permit is issued,it is a permit to proceed and grants no right to violate the
Massachusetts State Building Code or any other code,ordinance or statute,regardless of what might be shown or omitted on the submitted plans and
specifications. All information contained within is true and accurate to the best of my knowledge and belief.
All permits approved are subject to inspections performed by a representative of this office. Requests for inspections must be made at least 24 hours
in advance.
Signed: Russell Cazeault 12/9/2016 (508)428-1177
Applicant Date Telephone No.
Estimated Construction Costs/Permit Fees
Total Project Cost: $12,600.00 Date Paid Amount Paid Check#or CC# Pay Type
Total Permit Fee: $64.26 3/9/2017 $64.26 Visa:XXXX-XXXX- Credit Card
XXXX-0985
Total Permit Fee Paid: $64.26
THIS IS NOT A PERMIT
�PR�S� PERMIT Town of Barnstable *Permit#- O6"16961Iq
Expires 6 montlis from issue date
AUG - 9 20 - Regulatory Services Fee_f '-) COD
Thomas F.Geiler,Director ILI,
TOWN OF BARNSTABLE Building Division p►k
Tom Perry,CBO, Building Commissioner ���0 0
200 Main Street,Hyannis,MA 02601
www.town.bamstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
EXPRESS PERMIT APPLICATION - RESIDENTLAL ONLY
Not Valid without Red X-Press Imprint
Map/parcel Number ��
Property Address �-
ll
2-1kesidential Value of Work Minimum fee of$25.00 for work under$6000.00
Owner's Name&Address
ALtCX3 O"L ly rVIA v)-i L4&s 4�
Contractor's Name s �� t �vQ Telephone Number 'jgx?�Ad-94]7
Home Improvement Contractor License#(if applicable)
Construction Supervisor's License#(if applicable)
❑Workman's Compensation Insurance
Check one:
❑ Iam.a sole proprietor
I am the Homeowner
have Worker's Compensation Insurance
Insurance Company Name
Workman's Comp.Policy#
Copy of Insurance Compliance Certificate must be on file.
Permit Request(check box)
❑ Re-roof(stripping old shingles) All construction debris will be taken to
❑Re-roof(not stripping. Going over existing layers of roof)
QrRe-side ytylc,
*kep lacement Win s/doors/sliders. U-Value (maxirnum.44)
"Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc.
I
***Note: Property Owner must sign Property Owner Letter of Permission.
A copy of the Home Impro nt Contractors License is required.
i
SIGNA
7
Q:Forms:expmtrg
Revise061306
i
e �
v
�oFINE, Town of Barnstable
Regulatory Services
RkMSTABLE, Thomas F.Geiler,Director
MAM
039.
a
.�� Building Division
Tom Perry,Building Commissioner
200 Main Street, Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 508-862-403 8 Fax: 508-790-6230
HOMEOWNER LICENSE EXEMPTION
C� Please Print
DATE:
JOB LOCATION: (�( �i��}�V� <51', : gR,t,Yly,16 L.L:-::'
number street pp village
"HOMEOWNER": C� `J 3 �-� ,-C_)I
name home phone# work phone#
CURRENT MAILING ADDRESS: l vv �F}�(� C � C:� r
1, s�►�L= opt 0Z"6e
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
repul,rements.
Signa omeowner
Approval of Building Official
Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the
State Building Code Section 127.0 Construction Control.
HOMEOWNER'S EXEMPTION
The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions
of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such
work,that such Homeowner shall act as supervisor."
Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q,
Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly
when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed
Supervisor. The homeowner acting as Supervisor is ultimately responsible.
To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,
that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by
several towns. You may care t amend and adopt such a form/certification for use in your community.
Town of Barnstable *Permit# 3
�OFTHE r�Y,l, Expires 6 months from issue date
Regulatory Services Fee '
i BAMSTABIA
y X&M. ��' Thomas F.Geller,Director
�pTF 659. Building Division v
Tom Perry, Building Commissioner ^PRESS PERMIT
200 Main street, Hyannis,MA 02601 J U N 15 2004
Office: 508-862-4038
Fax: 508-790-6230 TOWN OF BARNSTABLE
E IA
XPRESS PEMT APPLICATION - RESIDENTIAL ONLY
Not Valid without Red X-Press Imprint
/ arcelNumber � 3i
Map/parcel ti
Property Address _
Value of Work �5)
Residential
Owner's Name&Address
e Telephone Number.
Contractor's Nam
Home Improvement Contractor License#(if applicable)
Construction Supervisor's License#(if applicable)
❑Workrnan's Compensation Insurance
Check one:
Fj I a sole proprietor
am the Homeowner
[] I have Worker's Compensation Insurance
Insurance Company Name
Workman's Comp.Policy#
Copy of Insurance Compliance Certificate must be on file.
Permit Request(check box),
[FRe-roof(stripping old shingles) All construction debris will be taken to
Re-roof(not stripping. Going over existing layers of roof)
B—Ke----sjide ��'� �-�
Replacement Windows.
U-Value (maximum.44)
*Where required: issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc.
***Note: Property Owner must sign Property Owner Letter of Permission. ?
Home Improvement Contractors License is required.
Signature 5 1
Q:Forms xpmtrg..
Revise053003
{ FORM B - BUILDING Area Form no.
} � P 210
N1, SS^.CHUSETTS HISTORICAL COMMISSION
204 lashinZton Street, Boston, MA 02108
` Towic Barnstable (Po.nd Villag
x
d-ti21�5ro : � R=�ta A M,^r.c- nlc
y -Historic 'Nauie Nelson Scudder n,• s o
h , 44 Use: Origiiial>Homes tead
Present -Residence
._. _ �•` '�' - ;M/M Norman Hayes
a OwnE: rship:E.Private-•individual
{. Private o=anization
Public
- Original owner
Dra . rip .sno ;ink property,'s DESCRIPTION: s ,
loch CMin ,'elat-ion to neares
cress. st_eets and other building-, - Date P�r'1 t6 l Rai
or geographical features.
Indicato Hart SoLtrca -Tiel"istry of rPPr3 c-R?T
a
Style ..edera? (Full Cape:)
krchitect
Exterior wall fabric wood shin,'
Outbuildings large darn rncure!� t--
Prens ,-„ location,
Major alterations (with dates)
nod'ernized'
Moved ' Date
Approx. acreage 6 3P C
J
P.ecordee,- by Patricia J, Anderson Setting Located . on, the norM, ;ido- nt
Orgr�ii_atfon rnstable Historical the County Rd-. .•(Rte . W yerlooklt
Commission ,+
Da-e June, 1982 the salt marshes , SandyNeck and
Cape Cod Bay,
Photo #50-5-P210,
F 4�' _
ARC-H?T ECTURAL,_S1GhIFICANCEl (describe important ,architectural features and f
evaluate in terms of other buildings., ithin community)
This''Federal"' style , ^'full Cape dwelling has several characteris4ti' +
of houses built in. the late 1700',s -b-d.w e.arly..'18OO '.s. - The front' `doorway,
sided, by pilasters`;""-has "'a ` fanlight above -a .hal,lmar�-_'of tthe Federal style
There are also quoins on_ the facade 'of: the.' *sin _section of. .the house-= `
another feature'nof 'the` ederah�st�yle. nn e11 containing..a kitchen, dining
area and. covered,.porch was added .,in the .early 19oa's" iIth :?nassive centra:lp
chimney 'stack;serves four fIrep1ace... openings. The interior_ of, ,the house-
consisted -of a: front parlor and, bedroom across the south 'side with a
keeping. :roo- across:. the back "or north:. s Lde of the house. .- The. second story ,
was used, "or Ded-To0mS an att1G.
iiISTCrcIC.�.' S_r';T: -'Or'= . Cexplain the role' ok-neTs plak
y.ecin local or. state history
zrr': no, t buifiaing relates to the.'develop ,ent of the .conil=ity)
_,.
The. land oz which this house' now. stands probably belonged tc Japes
rsmblen, one of the earliest settlers who arrived.-In Barnstable 'ln the
spring of 1659. Amos Otis ' notes state that "in. 1686 James Hapml blen,
Senior 's house, is described as standing- on his._twenty acre lot, on the
north side of the highway , between the houses of Mr, Russell (}mown in
oderr_ tires a Brick John Hinckley 's ) and Dea. John Cooper 's , now owned
b;_ Mr. Willia._i Hinckley and others. " (See- Form AYs ?-208&21.2)
The earliest rbmaininz. deed for this property was written An 1792;
Winslow Crocker sold 81 acres of land to ic,hn Hinckley. In 1801 John,
and Lydia Hinckley sold this` land to Capt. Asa Scudder (1771-1822) son of
Ebenezer. Deyo states , ."In 1806 the schooner COMET,_'150 70-95 tons
burthen, commanded. by Captain Asa Scudder, made frequent trips between
Barnstable and Joston. "
In 1841' Asa 's widow, Sally and children, Sally 2rd, Caroline, Hannah,
Daniel, Edward and. Lydia , conveyed to Nelson Scudder (1811-1887) a
parcel of land .V.ith 7 a dwell-ing house thereon. Nelson Scudder married
big=il Hasse in 1833 The other of the house was owned. by Nelson's
aothc, € ..11�- e _- lson and his brother ->:nie1 owned the Wharf (See Fora
i" _ ..nd or' the lane now caller Scudder Lane and a store at
the be�in -n_ o;: 'th-e 'lane behind Daniel Es house (See Form 9s F-178&.18R) .
After the death of the widow Sally Scudder in 1868, the other i
of the house was conveyed to Nelson by Sally 's heirs . The deed states
"I house iiproved by Sally -Scudder." The large barn located just north
of the house at one time stood near Scudder 's Wharf and was used as a
sail storehouse . -It was later moved to Nelson Scudder's homestead and
used as a barn by both Nelson and his brother, Edward. After Nelson
Scudder's` death in 1887,` the house and land passed to his daughter, Sarah I i
(Scudder) Parker, wife of Silas B. Parker. Sarah died in 1922 and by her
aria,%or R✓ FLENCES Cont.
Registry of Deeds Barnstable County
Registry of Probate-Barnstable County
Barnstable County'Atlas 1858, 1880, 1907
Deyo, Simeon, History of Barnstable County Massachusetts , 1896.
Otis', Amos,`. Genealosical Notes of Barnstable Families , 1 88.
20.: -2/80
INVENTORY FORM CONTINUATION SHEET C � - i t}' : Fore No:
Barnstable (Pond Vill :g`e:� F210
MkSSACHUSETTS HISTORICAL CaVISSION � J fr
Office of the Secretary, Boston �V "
Property Nam : Nelson Scudder Hou e
Indicate each item on inventory foim which is being continued below.
Historical Sig. Cont.
will the property was left to her cousin, Chester Bassett. The hom=stead
is still owned by descendents of Mr. Bassett.
Staple to Inventory form at bottom