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0208 LINCOLN ROAD
L� G!)Co�n , lqcl SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY ■ Complete items 1,2,and 3.Also complete A. Signature item 4 if Restricted Delivery is desired. Agent ■ Print your name and address on the reverse ❑Addressee so that we can return the card to you. �cWw d by(Printed,Name) C. Date of Delivery ■ Attach this card to the back of the mailpiece, \1 or on the front if space permits. D. Is deliMMA erent from item 1? ❑Yes 1. Article Addressed to: If YES,enter delivery address below: ❑ No o �-USS-P-S—' 20o Lt rcviN S� wn� ,sy M� o-upO 3. Service Type ❑Certified Mail ❑ Express Mail ❑ Registered ❑ Return Receipt for Merchandise ❑ Insured Mail ❑C.O.D., 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number (Transfer from service label) 7005 1820 0004 6479 20 36 PS Form 3811,August 2001 Domestic Return Receipt 1025$5-02-nit)-I15401 ...•r►.r•n•v wA..w`�' �.::��' .r„y..a'-A` �lf'.'.._!..'''/)ali. is(':!t!:':/i:'l::l(:::� i UNITED.STATES POSTAL SERVICE First-Class Mail Postage&Fees Paid USPS Permit No.G-10 • Sender: Please print your name, address, and ZIP+4 in this box • TOWN OF BARNSTABLE BUILDING DIVISION 200 NWN ST. Hy'ANNIS,MA 02601 T .,. F BARNSTABLE BUILDING PERMIT APPLICATION .�J Map Parcel Permit# Health Division L Date Issued Conservation Division ZF7,Z Application Fee Tax Collector Permit Fee ��� ' Treasurer l SEPTIC SYSTEM MUST BE Planning Dept. I%1 STALLED IN COMPLIANCE ��/ `O v VATH TITLE 6 Date Definitive Plan Approved by Planning Board EWRONFAENTAL CODE ANE Historic-OKH Preservation/Hyannis TOWN REGUUTIONS Project Street Address Village y a.h)A 'I S Owner + Mrrit Address Li h_coI4 U_ 6a in h S,-j" Telephone Permit Request jC"ev\. t >uWA\., 15 X o�g Square feet: 1 st floor: existing proposed LiMb 2nd floor: existing proposed Total new 1-!Zb Zoning District Flood Plain Groundwater Overlay Project Valuation t.'4, Construction Type LJ-pel> Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family 01_ Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑ �Yes o On Old King's Highway: ❑Yes l� Basement Type: 'Full ❑Crawl Cl Walkout ❑Other r Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing 2— new Half:existing new Number of Bedrooms: existing Z- new Total Room Count(not including baths): existing new First Floor Room Count 7 Heat Type and Fuel: ❑Gas 816 ❑Electric ❑Other Central Air: 0 Yes ��O Fireplaces: Existing New Existing wood/coal stove: es ❑No Detached garage:®'existing ❑new size Pool: ❑existing Cl new size Barn:❑existing ❑new size Attached garage:0 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 P iy BUILDER INFORMATION Name >try `b ( >AbY Telephone Number Address l Z License# Home Improvement Contractor# C � Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO c. SIGNATURE DATE 1, Ll��2 FOR OFFICIAL USE ONLY NO. JPAISSUED , MAP/PARCEL NO. ) , ADDRESS " - VILLAGE OWNER DATE OF INSPECTION: FOUNDATION ,6S F o YJ `f FRAME r INSULATION f FIREPLACE ELECTRICAL: ROUGH_ y FINAL PLUMBING: ROUGH, = i? s FINAL - GAS: ROUGH ,?- i= : FINAL - FINAL BUILDING € 'DATE CLOSED OUT ASSOCIATION PLAN NO. '• The Co"imonwealth of Massachusetts ,Department of Industrial Accidents Office ollnYestig8tlons . 600 Washington Street Boston,Mass. 02111 orkers Com ensation Insurance Affidavit R' / / / Poll name: location: • - v`C9�-�-f �'�j a�f • hone# [] . a homeo r performing all work myself~ I am a sole ro zietor and have no one workin in ca acl i %%%%%//%/�////�%/%////%//%%%/// � emwonan/this /////////%%% om ensation for my a9? 4 x•,.. < ;?<;z yf ;};X 1�eIS C T1 }.ac... ;.}•<?},v,'::; ° iirjG!'•::,1;• n^?f� < :`'. 3{> '` ,• ?;R$: i•F :�i:•n{: •dm work P, <4:•:{ •K4 :Fr}>:k:5.n ;a•+ ,}}::: .:5::,.•:).{ :F,.{.. 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Failure to�ecnr a coverage as required under Section 25A of MGL 15Z carilead to the imposition of erin►inal p enalties of a tlnenp to S1,S00.00 md/or one ye10 ars'imprisonment as well as dvII pe�ties in the form of a ti T V O DIAir g=R MCI e�rMcafion00 a dap againstma I�tder�Gmd that a' ed to the Office of Investig ' copy of this atatemeatauybe forward _ -: :�COtteci -- fyicndertke' cins-andpe alher-of-perjury•ihatthe-informaiian-pro-vided_aboueas�ct an_ I do hereby eerti • o Date • Signature Oi'''�r/`" .,. .,. . :" ��,..•• Sc9�'^L-f�d`��bi 3 j priest name r . Phone# official we only do not write to this area to b e completed by city or town oMdal - • permit/Iiccnse# (3Building Department dng oaril city or tow _ �gitecL- B n: Oiflr_ contact person: r . r ' r .Information and Instructions Massachusetts General Laws chapter�152 section 25 requires, employers eir S n °the servicede eof another under any for contract -employees.-.As quoted from `law , an employee is d every .. _.-.- ._ . _..,- .nf jire,'express or irqpR4 or9I or , association, corporation or other legal entity, or any two or more of An employer is defined as an individual, Partnership, _ 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 ssociation or other legal entity, employing employees. However the owner.of a. ..' dwel�g house ham not more than three apartmeats 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 onthe grounds or building appurtenant thereto'shall not because of such employment be deemed to be an employer. s M GL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance 6r renewal in the pliciat who of a license or permit to operate a business I ance with the i suranuce coverage r quired�Additionallyth for any pneitherthe h as not produced acceptable evidence of p commonwealth-nor any of its political subdivisions shall enter into any contract for the perfoanance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authoIIty. ` �.. - .. .. r,•. /�/ s��%���/.�� Applicants Please fain the workers' compensation affidavit c situationompletely,by checking the box applies to your and pPly�g company names, address and phone numbers along with a certificate of insurance as all affidavits maybe submitted the Departrneut.of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. ne•affidavit should'be retumed to the city or town that the�application�Sfor the permit he r�h'c�en�license .YQu being requested,not the Department of Industrial Accidents. Should y�i have y questions E obtain a jiorkeis' compensation policy,please calt;the Department atthe niomber listed below:.' aie 1equired,t6 igX _ City or Towns ' . ...._ • : -�- thatthe affidavit is complete and printed legibly. The Department Eras provided a space at the bottom of tie Please it sureInvestigations has to contact you regarding the applicant. Please. affidavit for you to fill out in.the event the Office of Y ,. ennrt�lrrcense number which will be usEd as a iefeience number. Tlie affidavits maybe r . be sure.to fill in the or FAX unl thei arrangements have been made: the Dep en e'ss o artm ��•tbv•• ••JGSv r 7.• . .,(, ,,The like to thank you in advance for you cooperation and should you have any�ne•.a LLonS. Office of Investigations would • ,. . please do not hesitate . give us a call. The Department's address,telephone and fax number. The Commonwealth Of Massachusetts ._Department of Industrial Accidents ' t3ttice of inYestlgatlans • 600 Washington Street t' Boston,Ma, 02111 fax#: (617) 727-7749 ' "r%'„a ii• (6117) 727-4900 ext. 406, 409 or 375 P��ftHE 1ph� Town of Barnstable Regulatory Services saaxsrnsLE. Thomas F.Geller,Director 9`bp N. 16119. a`�� Building Division rED MP'� Tom Perry,Building Commissioner 200 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 or building be done by registered contractors,with certain exceptions, along with other requirements. Type of Work: r7G Estimated Cost Address of Work: Owner's Name: 0 Date of Application: N -®�-- I hereby certify that: Registration is not required for the following reason(s): []Work excluded by law ❑Job Under$1,000 OBuilding not owner-occupied ❑Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the o -(t{-v Z Date ntractor me Registration No. OR Date Owner's Name Q:forms:homeaffidav 41- 74 Board Of Building Rtgulations nd Standards HOME 1MAOVEIIIENT CON2 TRACTOR _. Registrationlot 44561 —nMi r DAI VID GADY CAR David Gady 121 Timber Ln Marstons Mills,MA 02648 Administrator L ; ------------ ------ J0le4SIu!wPV MZO--�VW -S11IW SNOISUVVI 3NYJ�i3eWlj.tZ avo r CIIAVO -4 09901. :0U -L OVSL90 ,,SU,2q9qwnN NOSIAN21dn NO119nuiSNOO :8SUG311 SN6uv-1n93m)Nia-1jn9:jo CINVOS - - -- --- - i i --------...-..__..� I ' f -- .-.._ l-- --�-- -- -i--- --- _ �I I i 01 _ -- -- - --- -- - L vi 1 e It L: i 1 i �- 1 . - - D i I i I i ta�._- - - --- ---�--- - .._..... L I I � �r �� � �� J_ . I i � I, _ � 11 � � I 1 � I. . ��} } t 1� �_ is� � rt1-1 � � � t � I F1 � � ' ----------- ................. alit i � Lft � Fj li i �` - � j 'FI � ' i � �� � � IT �==a1 . -- Lk i LL tit. F+ i, � i 1 14 JL- I 4'r -P.T. ............ ------- t vo-- 14 ------------ sl Y cI 4 14 ZOP ` 5" O l"fp Op, LOT - (� cl� GAR. p'-==--_- - I-IS l 4 o—— ' c � 1 N �715 55 tY cp SIZED LOT 43 a E t NOTE'' PRE—E'XISIING NONCONFORMING. J RL'S. ZONE. "RCl" Phis MORTGAGE INSPECTION Plan t9 For I'LOUD ZONE.' "C" Bank Use Only .'TOWN: -,U)A J ------------- REGISTRY OWNER: _ LORING I.._AOEDELI JR & ELI7ABETH A_ TiO D-aL DEED REF: ----------- DATE: 11/—0/9.2 _____------ PLAN REF: -58-119 _9____ ______SCALE:1"= 30'__FT. �. o��d , -- �1 I HEREBY CERTIFY TO FIRST ITDEI7A.L SAVINGS & I0AjV AS50C OF_ roCtJE_STER ITS S_UCCESSORS_.w_DIOR ASSIGIVS A7yyATI-IA'r THE BUILDING ��i��p� 41'Ij?o� YANKEE, SURVEY SHOWN ON THIS PLAN IS LOCATED ON THE GROUND AS �o PAUL � CONSULTANTS �. SHOWN AND THAT ITS POSITION DOES ---- CONFORM s A. TO THE ZONING LAW SETBACK REQUIREMENTS OF THE U MFRITHEN 143 ROUTE 149 TOWN OF _ RARNSTABLF'------------- NQ.32098 °j MARSTONS MILLS, MA. 02648 - AND 'rttA�c - p IT DOES _.NOT _ LIE WITHIN THE SPECIAL FLOOD IIAZARD ��s sErISIE?%'``" TEL: 428-0055 AREA AS SHOWN ON THE H.U.D. MAP DATED&119Z84__ FAX: 420-5553 C nmunit —Panel g 250001 0005 C _____ THIS PL AN NOT MADE F 10075 BJS ROM AN INSTRUMENT' T'AIJL A. ERI' MEW YL SURVEY NOT TO0 DE USED FOR FENCES ETC. --- f P`oFIHET Thee Town of Barnstable N T BARNSTABLE. Department of Health Safety and Environmental Services MASS. M 9� i639• `00 r "rEO 39 Building Division 367 Main Street,Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 PLAN REVIEW Owner: zt Z W o LLD 0--&�L. Map/Parcel: a-270/o y 7 Project Address: 20Sr)/Ncolw �17, ' 11yN Builder: , !// t� (r, .D q r ' The following items were noted on reviewing: �O IZG-e�l� Col y 601 TH 6-9-r-r C Az' � Fr t-G YL E-C�-1 t 0Ite/2 11 I% -L )l 5 5iV-o ov �i� /"�TT lac-/��J -..•,��i��-i— • Reviewed by: /�. Date: aAl Z— q:building:forms:review c 7Z� * ` ^1 ` . TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map 2-7 t Parcel 4 2-7 ` '." Permit# 3,9 S�5 Health Division � - ��� Date Issued Ti Conservation Division /1j 3 /)41c "VS-rACC.®ST�IV��US. Fee Tax Collector ��� f3 ".11 to�LfA�,of Treasurers d2J s . . �p Planning Dept. Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address _ O g Lk_,_o Z� Village f 1�`1awK�s Owner Lbv!,4 LA.)O_L � - r Address 20 x Telephone `� ?V__ Al l Permit Request (vr,�101,1_*_ 3 Square feet: 1 st floor:existing proposed ` (03 2nd floor: existing proposed Total new y g Estimated Project Cost McOO Zoning District Flood Plain 1�Groundwater Overlay f Construction Type (moo(P-b Lot Size a c7 Grandfathered: Q Yes ❑No, If yes, attach supporting documentation. Dwelling Type: Single Family ® Two Family- ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes ❑No On Old King's Highway: ❑Yes ❑ No Q� 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 c Number of Bedrooms: existing new \� Total Room Count(not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil ❑Electric O Other r Central Air: ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑'No Detached garage:0xisting l(new size 4-9 Pool:dexisting ❑new size Barn:❑existing ❑new size Attached garage:❑existing ❑new size Shed:❑existing ❑new size . Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ { Commercial El Y U_/ If y`s,site plan review# Current Use — < Proposed Useo�� BUILDER INFORMATION Name zg v �Z , Telephone Number _6 3 l� r Address iZt ' 'mow(o" L.�. - License# x 6S-IS`f Q' MA-_ O}_ qk Home Improvement Contractor# � 1 HSro I Worker's Compensation# MAY ®04I 13 q 0 Z ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO Cov►.�w�ev�F.Q [� SIGNATURE., J1 DATE 71 p Q s— FOR OFFICIAL USE ONLY " PERMIT—No., DATE ISSUED MAP/PARCEL NO. ADDRESS =_ ' r �, ' VILLAGE OWNERT DATE OF INSPECTION: 'FOUNDATION 7 FRAME .— Js Y...J. � � ` • .y + 1. ' ` INSULATION FIREPLACE ; ELECTRICAL: .ROUGH. 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Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address0 g (.,�••c,a l Za Village 9 A.v.11 u Owner al Address 20 Telephone 110 `l 7f A4 I V1 Permit Request Square feet: 1st floor:existing proposed `4(03 2nd floor:existing proposed Total new 1 8 Estimated Project Cost (J eoO Zoning District Flood Plain Groundwater Overlay Construction Type W00-b Lot Size gt D Grandfathered: ❑Yes ❑No If yes, attach sup docume p g n on. Dwelling Type: Single Family 0' Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: O Yes ❑No On 01 King's igh es ❑No Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new Half:existing new Number of Bedrooms: existing new Total Room Count(not including baths):existing new First Floor Room Count N Heat Type and Fuel: ❑Gas ❑Oil ❑Electric ❑Other VCentral Air: ❑Yes d❑�-No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑No Detached garage:e�/xisting @new size qb 9 Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: Zoning SUM' Appeals Authorization ❑ Appeal# Recorded❑ Commercial' ❑Y fV If y s,site plan^review# - -- , Current Use r �. - - Proposed Use �c r dct „ 2 BUILDER INFORMATION Name �( s', .� � Telephone Number _ Z Y—i�a 3 lb Address_ Uxt 'mow loe. L� License# b57S 4 D OA6^-`�^"'� ` off' Home Improvement Contractor# 11�J b Worker's Compensation# _ 3'8'( @0 4 S 0 Z, ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO Cam,..eve 6-F, 110v SIGNATURE. DATE Y FOR OFFICIAL USE ONLY PERMIT NO. 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EIU8TN0 CABLE E218TN0 WINO EMYNG GARAGE tXS RNOE BOMD 2SS PURLN TXS PURLN NEW OMB REL ROOF RAFTFR8 AND COLLAR TE8 iA•O.C. NEW CM PORT SEXTEND CAR PORT - I.et8 R.Q.EVERY IV) ROOFOVERECI G GARABE MEAD MD FOUNDATION ' 28'a• NEW ROOF OVER EXISTING GARAGE e•r DOUBLE as L PLATES TRILMEDn..RTOP OF TOP PUITFA ES MATCM DOUBLE 2X{PLATEEICSTITOFTOPPLATESNEXSTNO OARAtiE Xt PT NNEM GABLE END STUDS IS•O.C. RACES E)WMG GARAGE BNPSON COWN01 BASHPdSMBCBS" 2.a.. ROi D O G O CENTER GABLES-6 REQUIRED ELEVATION OF NEW CAR PORT ENTRANCE GABLE.ONE REQUIRED rr EXWIs10 oARAOEwew am II•r r1r eDPTNo EAELe EmTna wfNo E]WTNO GARAGE XN'd aP RDOE BOARD a{O(.NMUG Ifs PURL" COLLAR .RO°F RAPIERS ' TER•I/'O.C. MEN CNI OORT sEfTI1D CAR PORT OYRlDlVEflTis'IOARMIE AREAS a•r NEW ROOF OVER EXISTING GARAGE a•r r•1r rr . rr � ••r DOUBLE as Am r� PUIeEiRENM® afILEDWE . TOP Of TOP PLATES TO MAMM DOUBLE a{PLATE MENNT of TOP PLATES N 444 PT E100TNOOMAOE PPOS PT f SUGAWAWM' BTt=Ir•O.O. EIRTNOOARAOE 1'd *Ial.lE COLYaN BYE MR UB sOAsoM COLD fiO LN s'r• CBSN 1rd - c T•1r N• C - rr ram- e p o p II I o' • lrow--+1, � 4 b ° CENTER GABLES-{REOYNIED ELEVATION OF NEW CAR PORT ENTRANCE GABLE•ONE REQUIRED of TMe r� The Town of Barnstable • usxsrABI.a. • 9MAM Department of Health Safety and Environmental Services 059. Building Division 367 Main Street,Hyannis MA 02601 Office: 508-8624038 Ralph Crass-en 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: 'Cam it Estimated Cost f 2 00 Address of Work: aos Owner's Name: L16 W•�.4 �t u Date of Application: 14 - 3 `� 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 for a pgmit as the agent of the owner: t (-3-S? 'Of eJ /i q Date Contractor Name Registration No. OR Date Owner's Name q:forms:Affidav I --- -_- - The Commonwealth of Massachusetts Department of Industrial Accidents Office ofiolyesm9atioos 600 Washington Street Boston,Mass. 02111 Workers' Com ensation Insurance Affidavit name: ti S7 C3' location: ��- city wK ti•:S hone# <XnB 4;2,1, ❑ k6n a homeowner performing all work mvself. I am a sole ro rietor and have no one workin in any ca acity %%%///%%%%%%%%%%O�%O/��%%%/%%%/%G/%���%��/%%%���/�/%////////'.��';; ❑ I am an employer providing workers compensation for my employees working on this job. compnnv name: address: city phone#: insurance co. Rnficv# ///m/////////// ❑ I am a ole proprieto general contractor, or homeowner(circle one)and have hired the contractors listed below who have the following workers' compensation polices: companv name: address. city: phone#: insarnnce co. _. olive# company name: address: - city: phone M - _... insurance co. pollev# Failure to secure coverage as requited under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a tine up to 51.500.00 and/or one years'imprisonment is well as civil penalties in the form of a STOP WORK ORDER and aline of S 100.00 a day against me. I understand that s copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certify under the pains penalties of perjury that the information provided above is truo and correct c. Signature Date Print name m 4 yt t�, y� G t4 DY Phone# -SOd-`t 2-b'-6ca30 Ccontact only do not write in this area to be completed by city or town official n: pernnit/license# []BuildingJ ❑Licensi f immediate response is required ❑Selectm (]Health rson: phone#; ❑Other (sewed 9195 PIA) Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the "law", an employee is defined as every person in the service of another under any contrz= 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 c: trustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer. MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally,neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority. Applicants Please fill in the workers' compensation affidavit completely, by checking the box that applies to your situation and supplying company names, address and phone numbers along with a certificate of insurance as all affidavits may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the"law"or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. City or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. The affidavits may be returned 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 8mce of lavesugatlo1ls 600 Washington Street Boston;Ma. 02111 fax#: (617) 727-7749 phone#: (617) 727-4900 ext. 406, 409 or 375 I 4 j `%•y ;v�.`"' a '.`�• `mow v �'� i 1 m .v 'r0 rti!rr � rn 7.0 4i v r Cl', If y ' i '� n I i i :� x a � I .9 i. ! F., 7 � � a e� en�.c o y _ . � � zy as l.. a�m4'�� ti,",�s �:. _ as (( o,.�rn �`. . f � �� f !I�i( � f7: i'� � � � �.,� +1 i; � T 1 t I i� a ��l_ �'.? •-•...��rn x v .�:.. -_..x H .c b . ao .1 m .-- N v va I�' W m m � c F-r 'f rn m a c-� E i . � � N _ � rn rn f� t' Y --� � N w rn 4- ^I N � 1t. ,y � � t � i. a 4: �* r. �. .. AssessVs offioe Ost floor): t} a lY'�' EpTIC SYSTEM MUST Q�TNEro Assessors map-and lot number ... . ..7Q:."�..,0.�.�:......'. a- Board of Health (3rd floor): .� IN COMP��_ Sewage Permit number ........................................... _2 BARNST&BLE. . Engineering Department (3rd floor): ') /� {J ' ('u � f +o jA°a House number .2 O t .^v, ��/� :._��. ODD YpV.a`em APPLICATIONS PROCESSED 8:30-9:30 A.M. and 1:00•2:00 P.M. only TOWN 'OF BARNSTABLE ROIL I G INSPECTOR APPLICATIONFOR PERMIT TO ............................................................................................................................. TYPE OF CONSTRUCTION ............V6FtA.P....... 15, ........ w(JO ....... 7!'� ........ ....... ............m z 7 TO. THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: s Location ....Q21 . .......d.WC.QJA! .......F,.j..........H �vli�.... . �� ......... oL. O. ............................................. Proposed Use .........C_Ihrn'e..........zet- .P-om.'$ . ....... s . ........................................ Zoning District ....................49.........................................: Fire District .... ..1mvU.1. ..r................................................. Name of Owner .Qf.uS.. ... ,�2.GtGI..: .1......Address Q.,�...p�,�MGrt�! ....P.(s.�...../..7.�,1��'lS.t. Name of Builder / :4M:c....................................Address .....................6/ .....................`...................... Name of Architect ..........!'55AM:0..........................................Address ..............(S.f'9!.. 'f...................................................... Numberof Rooms ......3......................................................Foundation ........... 1.1.5........................................... Exterior .......(,5k`74...�....................................................Roofing ................ ...:...........................'.......... .... Floors X.(:�1..S1S...............................................Interior ..............V....{'lt.C1. .... Q.4. ..i..................;........ i$/.1.. .. ...........................................: Plumbing +►�' 70 Heating iY �' g l�U .y....vC./.l'C/�/... ..�.!.... ......�.�.�RJ Fireplace .............f!! .(...........................................................Approximate Cost .... 031.Q�®............. ------f 9-------- • Definitive Plan Approved by Planning Board -------------------------- c/ Area .. ......�.1....���!�........ Diagram of Lot and Building with Dimensions Fee ��......".�'............... SUBJECT TO APPROVAL OF BOARD OF HEALTH OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. --Name ... ....cf...... ............ .......... ..... . ... .................. Construction Supervisor's License .................................... WORDELL, LORING W. JR. A=270-047 :1 Vdditi -No Permit for ...Build...................gn Sinqle Family Dwell-* .........................................................!A Location' .. 208 Lincoln Road .............................................................. .............. ........... .................................... Owner .... ........Worde.".Type of Construction .........Frame ................................. ........... ................................................................... P116t .........I.............. Lot ................................ Sept. 11 , 87 Permit Granted ........................................19 7 Date'of Inspection ..... .............1 9,P-,,74� Date Completed .......................................19 14� V-1 ;Assess(r's offioe (1st floor): *1 Et "Assessor's map and lot number ...a.24. Y..7......... .,.. Board of Health (3rd floor): 75 `Sewage Permit number ............................ ..................,........ Z BAHd9TABLE, Z Engineering Department (3rd floor): ��J b o'" rasa �J o /� ��p,i639 \e°j House number ...................................... .C.,............................L. P£0MAR 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 ............ 1f C......�'...{g .................. �i�aa .......�PA/!1.ti°........ !•...........19.g7 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location .... ....... .f 11Q1 !>.......1�4........../..1. A(lUl .... . /...........U �aQ �..... ........... ................ i n Proposed Use 291 qOM.,$...... - ..®. .ae........73!I.k................................ ...............................................Fire District Zoning District .......... .... i4Vf!.5.................................................... Q Qk u GCS p ! T2 �., ti �c, %4 Name of Owner .................�...........�Q.(?.G.�•:f..,.f ....................Address ... ..�............ . d....�a.r<....................�.Lt✓�}�!..... Name of Builder .-5A.M ......................Address .......... 4SH.M....�` . Name of Architect ..........SUM .........................................Address ............... FiM ...f.................................................. Number of Rooms ......3......................................................Foundation ...........�`/1' .5 /. ........................................... Exlerior ....... . ....................................................Roofing ................ shy ....................................................... Floors X f-dib� ...................Interior ............. OCi� J............................. /......:-.�. I/ n Heating ............ X15f1,U ................................................Plumbing 1........Y..,9,. ...✓d./. l ... t V K .. �.�.UR��\ Fireplace ............. .a...........................................................Approximate Cost .... .a19©.............�............................. Definitive Plan Approved by Planning Board --------------------------------19-------- - Area �.. ..p. ......... Diagram of Lot and Building with Dimensions Fee ot SOBJECT TO APPROVAL OF BOARD OF HEALTH ti OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. f ' Name .. .�.. � Construction Supervisor's License .................................... WORDELL, LORING W. JR. A=270-047 31186 Build Addition No ................. Permit for .................................... Single Family Dwelling Location 208 Lincoln Road Hyannis .....................................................................I......... Owner , Loring W. Wordell, Jr.. ................................................................. ' Type of Construction ...Frame ............................................... ............................... Plot ............................ Lot ................................ Permit Granted 87 Date of Inspection ....................................19 Date Completed ......................................19 �� U l CERTIFY THAT THIS SURVEY AND PLAN WERE MADE BARNSTABLE ' IN ACCORDANCE WITH THE PROCEDURAL AND TECHNICAL `STANDARDS FOR THE PRACTICE OF LAND SURVEYING IN T OMMONWEALTH OF MASSACHUSETTS. E 28 UT o LOCUS PA UL A. MERITHEW, P.L S. DA T— OF — LET 45 �' �a►� s�, �-Q.r�,. . / CB / 1 � �, � MER1THE1gi O -e No. 320M } �'Fs�'�fC15FEaESJ� ii AMA( lkM� I 454 14(,? 00 , LOCUS MAP CB ASSESSORS MAP- 270, LOT 47 PLAN REP 58/99 5. Capov Y.< <'J —__ `5 O RES. ZONE: »RB» ---.SHOP-— O SETBACKS (20/1O/10) �1 FLOOD ZONE. C l� Q 46 c - —_ _ _ ___ _- 015 COMMUNITY PANEL# 250001 0005 C DA TED 8/19185 �J - - - - - - - — — _-- — -HSE': Cl) C15 CV PLOT PLAN Zle 3 ,� OF LAND NEy O LOCA TED IN ON BARNSTABLE, MA. O' N PREPARED FOR ��1`5 55 LORING WORDELL IY ` SHED OCTOBER 22, 1998 Zor 43 YANKEE SURI/EY CONSUL TANTS P. O. BOX 265 1 UNIT 1, 403 INDUSTRY ROAD i MARSTONS MILLS, MA. 02648 GRAPHIC SCALE^ PH.(508)428-0055 — FAX(508)420-555J 20 0 10 20 40 80 ( IN FEET ) I inch = 20 f t. Jf 51733 DCB