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HomeMy WebLinkAbout0325 MEGAN ROAD �o�q'71 ACTIVE Anderson, Robin From: Flynn, Margaret Sent: Tuesday, December 15, 2020 2:45 PM To: Anderson, Robin; Puckett, Carol Cc: Shea, Sally Subject: RE:Appeal? Taniel was instructed to prepare a business plan for Brian to review to see if an assisted living facility would be possibly approved at 325 Meagan Rd., Hyannis. She has yet to submit. Hope this information is helpful Maggie o0E%.ov It Maggie Flynn z Permit Coordinator I Planning& Development z Town of Barnstable 1200 Main Street I Hyannis, MA 02601 margaret.flynn@town.barnstable.ma.us lO�N OF BARN P 508-862-4679 C 508-776-7495 From: Anderson, Robin Sent: Tuesday, December 15, 2020 1:57 PM To: Puckett, Carol Cc: Shea, Sally; Flynn, Margaret Subject: Appeal? Hi Carol, Do you have a decision or an appeal pending for Rogers at 325 Megan Rd, Hyannis—assisted living facility in a residential setting? R291-256. She is now applying for a license to operate a transport vehicle and if she doesn't have ZBA approval —she does not need a transport vehicle or a license at least at this time. Please advise. Thanks, Carol. 0�96k Robin C.Anderson Code Compliance Manager 200 Main Street Hyannis,MA 026o1 5o8-862-4027 1 Anderson, Robin From: Puckett, Carol Sent: Tuesday, December 15, 2020 2:28 PM To: Anderson, Robin Subject: RE:Appeal? Hi, I have nothing on that address. Carol Carol Puckett-Administrative Assistant Zoning Board of Appeals& Land Acquisition and Preservation Committee 200 Main Street Hyannis, MA 02601 508-862-4785 The Town of Barnstable is operating and providing critical services to our community. Town offices at Town Hall and 200 Main are currently not open to the public through May 18th and many of us are working remotely. Staff is available remotely and meetings are being scheduled by appointment only. The best way to reach us during this time is by e-mail, but you may also leave a message at 508-862-4703. For updated information on the Town of Barnstable's response and resources related to COVID-19 visit www.BarnstableHealth.com. Thank you for your patience and support as we continue adjusting to the COVID-19 outbreak. From: Anderson, Robin Sent: Tuesday, December 15, 2020 1:57 PM To: Puckett, Carol Cc: Shea, Sally; Flynn, Margaret Subject: Appeal? Hi Carol, Do you have a decision or an appeal pending for Rogers at 325 Megan Rd, Hyannis—assisted living facility in a residential setting? R291-256. She is now applying for a license to operate a transport vehicle and if she doesn't have ZBA approval —she does not need a transport vehicle or a license at least at this time. Please advise. Thanks, Carol. �obk Robin C.Anderson Code Compliance Manager 200 Main Street Hyannis,MA 026o1 5o8-862-4027 1 a r Town of Ba table Police De par ent p ; Matthew K.Sonnabend,Chief of Police t: � # '7 Main Number: 508-775-0387 a, x Sean E.Balcom,Deputy Chief of Police 02601V Main Fax: 508-790-4167 Mark J.Cabral,Deputy Chief of Police " Administration: 508-775-0920 Admin.Fax: 508-790-6317 www.bamstablepolice.com APPLICATION FOR VEHICLE FOR HIRE—OPERATOR'S LICENSE LICENSE FEE- $40.00 Date of application: Las First Middle Initial Address City Phone Number Place of Birth Mother's ame Father's Name Height Weight Eye Color Hair Expiration Date To Be Employed by: Si ture Licensing Authority Use Only: Dispatch Call#: BOP check IMC check RI check Coplink Approved Denied By: Remarks: Issued On: Fee Paid Serving the Villages of Barnstable, Centerville, Cotuit, Hyannis,Marston Mills, Osterville, and West Barnstable TOWN OF BARNSTABLE B*F�N t"T A B L�E MASSACHUSETTS i Vl ii? CL f_r1�( BUSINESS CERTIFICATE ATE ISSUED: 06/28/2019 DATE RENEWED: BOOK 208 RENEWAL BOOK: RENEWAL PAGE: AGE: 19-560 DATE DISCONTINUED: CERTIFICATE EXPIRES: 06/28/2023 DISCONTINUED BOOK: DISCONTINUED PAGE: In conformity with the provisions of Chapter One Hundred and Ten(I 10),Section Five(5)of the General Laws,as amended,the undersigned hereby declare(s)that a business is conducted under the title below,located as shown,by the following named person,persons or corporation: PLEASENQTE'< A BUSINESS CERIIFIGLI�TENDICATES THATTHNAMED PER $}jS SON (ARE DOING BUSINESS UNDER kIAME DIF�EREN'�.�Ff�kN tI1S/HJ=R`PER,SONAi�NA1IAE(S)�,1�-<DfOES NOTIMPL1f�,Tifi/C"�%�EIE�A��LICANT(S�HA'S(�IA\fE�'IVIET%CL��tIGENSE� '�` I?ER�III�.�WD�QTEIER,PER11AlSS101�°REQUIRED BYTL{E'TOWI�OFB7�RNSTABL�BtI1LDING.[1EALTH AND CONSUNIERAFFAIRS �-' DEP;f�RTMEN,TS',�F)R TH�LEGAi OP-ERATIOIV�OFTHIS BUSINESS ATTyESTATED LOCATION` �' � F�' '�"�� �'P�';`' _.r:.:...x.�.i��,s.:...s_..:�.i....:.:....:.t.....: -Y'....+.....r....:....:::.�.:..`.......�-......- ... _.�:..-..c ..,.:.r.�...,4,. ..•.:a.......... ..-a..... .a,_....u.1 Y:ds....L ..._.,_._.�.. CHERRY'S HOME HEALTH CARE MAILING ADDRESS: 325 MEGAN RD HYANNIS,MA 02601 TANEIL ROGERS 325 MEGAN RD HYANNIS,MA 02601 �j Signatures: � x THE ABOVE NAMED PERSON(S)PERSONALLY APPEARED BEFORE ME AND MADE OATH THAT THE FOREGOING STATEMENT IS TRUE. TITLE Identification Presented: DATE: July 2,2019 CONDITIONS: 07/0212019 NAME CHANGE NEED TO ADD HEALTH TO NAME:CHERRY'S HOME HEALTH CARE NO CLIENTS OR EMPLOYEES TO THE HOME. ADMINISTRATIVE OFFICE USE ONLY. NO SIGNS. In accordance with the provisions of Chapter 337 of the Acts of 1985 and Chapter 110.Section 5 of the Mass General Laws,Business Certificates shall be in effect for four years from the date of issue and shall be renewed each four years thereafter. A statement under oath must be filed with the city clerk upon discontinuing,retiring or withdrawing from such business or partnership. Copies of such certificates shall be available at the address at which such business is conducted and shall be furnished on request during regular business hours to any person who has purchased goods or services from such business. Violations are subject to a fine of not more than three hundred dollars($300)for each month during which such violation continues. CERTIFIC TION CLAUSE I c ' nder the penalties of perjury that I,to the best of my knowledge and belies;have filed all state tax returns and paid all state taxes required w. 0�6 5� * Signatur ndiv' r Corporate Name(Mandatory) By: Corporate Officer(Mandatory if applicable) ** or Federal ID Number * This license will not be issued unless this certification clause is signed by the applicant. ** Your social security number will be furnished to the Massachusetts Department of Revenue to determine whether you have met tax filing or tax payment obligations. Licensees who fait to correct their non-filing or delinquency will be subject to license suspension or revocation. This request is made under the authority of Mass.G.L.Cha 62C,S.49A. Town of Barnstable Regulatory Services Director Richard Scali Regulatory Services 1? �D1 onsumer Affairs Supervisor • � +a Weights and Measures Progra 1 G z .Hartsgrove 200 Main Street,Hyannis,MA 026U � ''�• Telephone: 508-862-4671 Fax: 508-778 2 Wei"is& e Trogram www.town.barnstable.ma.us e s Jane; a `'cz b/n The Vehicle for Hire Permit must be submitted with: �- 1. A detailed explanation of your assessment of the need for additional service in the areaofyour application. 2. Copy of Insurance Certificate for the vehicle. 3. Business Certificate 4. CORI form , 5. Fee: $50.00 per permit $50.00 per vehicle $50.00 semi-annual safety inspection fee REQUEST FOR VEHICLE FOR HIRE PERMIT -NEW Type of Service Proposed: Taxi❑ Limousine❑ Other Public Automobile❑� Name Cherry's Senior Care Services d/b/a Cherry's Home Care Phone 508 322-1119 Cell Phone 347-6595342 Business Address 025 Megan Road Hyannis MA, 02601 Mailing Address 325 Megaqn Road, Hyannis, MA 02601 Email Address info@cherryshomecare.com Vehicles to be garaged at 100 independence Drive Hyannis MA, 02601 Proposed Number of Vehicles Number of Employees Hours of Operation —:3 (A 1D , If vehicles are to be operated from fixed location, state location(s) (Bus station,train,etc.) Description of vehicles to be utilized THIS PERMT REQUIRES A PUBLIC HEARING AND THE TOWN MANAGER'S APPROVAL Approved: Town Manager,Thomas K.Lynch q:\wpfiles\pkgw&mveh\vehiclest&l\vehfhirepermit The use of vehicle A handicap accessible van is a vehicle that is made with an increase in interior size and is equipped with the means of wheelchair and stretcher entry using a ramp. This vehicle will be used for non-medical transportation service only for seniors in the communities we offer our service and clients of Cherry's Seniors Care Services D.B.A Cherry's Home Care. These are seniors that do not have access to transportation that meet their disability needs. Most of these clients are wheelchair-bound, bed-bound or has limited mobility. Cherry's Senior Care Services is here to help the senior community to our full extent. We understand most times seniors are not able to make it to their Doctors or personal appointments because they do not have access to a handicap accessible vehicle. Also, a patient may be discharged from the hospital and do not need an ambulance to take them home but does require handicap accessible vehicle. Therefore,we would like to offer this service to our seniors helping families take care of their loved ones and giving that peace of mind. Our service areas are the Mid-Cape,Upper Cape, and Lower Cape. We will operate from 7 a.m- 5a.m At this time,we do not have a copy of an Insurance Certificate for a handicap accessible vehicle; we have not yet purchased. We assume it would be better to meet with the Town of Barnstable and see if we would be approved; once we have the go-ahead,we can buy this handicap accessible vehicle and have all the proper insurance we need and provide to the Town of Barnstable for final approval. Please bear in mind if we go ahead and purchase this vehicle with no approval from the Town and not able to provide the service,we will then be at a loss paying for a vehicle that is not being used for service to the business. I would like to set a time to have a hearing to further discuss. Thanks Taneil Rogers 4 Shea, Sally From: Anderson, Robin Sent: Tuesday, December 15, 2020 1:57 PM To: Puckett, Carol Cc: Shea, Sally, Flynn, Margaret Subject: Appeal? Hi Carol, Do you have a decision or an appeal pending for Rogers at 325 Megan Rd, Hyannis—assisted living facility in a residential setting? R291-256. She is now applying for a license to operate a transport vehicle and if she doesn't have ZBA approval —she does not need a transport vehicle or a license at least at this time. Please advise. Thanks, Carol. dLo6& Robin C.Anderson Code Compliance Manager 200 Main Street Hyannis,MA 026oi 5o8-862-4027 1 Shea, Sally From: Shea, Sally Sent: Monday, November 09, 2020 1:02 PM To: Flynn, Margaret Cc: Anderson, Robin Subject: RE: 325 Megan Rd., Hyannis 2917256 Hi Maggie, Yes. They have a home occupation registration for administrative office use only and all clients were off site. Now her proposal appears to have changed to include on site clients and staff. A small assisted living facility in her home. Hope that explains things. Sally Shea Town of Barnstable Assistant Zoning Admin/Lead Permit Tech. -508-862-4031 From: Flynn, Margaret Sent:Monday, November 09,:2020 12:06 PM To: Shea, Sally Subject: 325 Megan Rd., Hyannis 291-256 Hi Sally Does this location have a home occupation business? If so, can you tell me what she has been approved for? Thanks. Maggie OVOPM4, Maggie.Flynn �O OVA z "14�3 Permit Coordinator I Planning&Development g i Town of Barnstable 1200 Main Street I Hyannis, MA 02601 �J margaret.flynn@town.barnstable.ma.us - T��HOFenacastP°�� P 508-862-4679 C 508-776-7495 — 1 i t Shea, Sally From: Anderson, Robin Sent: Tuesday, October:06,2020 2:00 PM To: 'Taneil Rogers' Subject: RE: Residence to Asst Living You will need to inquire with the Secretary of State's office concerning how to officially organize and what the best options are for your intended purpose. You may want to speak to an accountant and/or an attorney on how to approach this and to identify the required elements. I am unable to direct you or offer any additional detail as I am not well versed enough in matters concerning the state and I do not want to inadvertently misdirect you. Robin From: Taneil Rogers rmailto:taneilrogers yahoo.com] Sent: Tuesday, October 06, 2020 12:25 PM To: Anderson, Robin Subject: Fw: Residence to Asst Living Hi Robin, My name is Taneil and I would like to•follow tip with you on the email below. This email is way back but I would still like to proceed To refresh-I have a private Home Care agency providing in-home care to seniors in their homes. As the business grows and I see the need for my service I would like to help more seniors. I would like to extend my service by turning my private home into a small assisted living home. I live at 325 Megan Road in Hyannis: I am not sure of the zoning area and if this service can be provided in my home.I will be willing to make the-necessary changes to the home to meet the requirements. Would you be able to tell me the requirements needed from the town to make this possible.? I know you have responded.- She first needs to show she has organized with.the state including a mission statement Once she hasher documentation we can discuss her proposal and it may require spr(tbd). I was not.sure what exactly you meant by organized with the state- did you meant to have my business entity registered with the state of MA-If so, my current business does. This will be additional services frorn-my business. What other documentations willi need? I would like to move-forward to discuss my proposal. However, I am not sure what is spr(tbd). . Can you please help me with some information?? - - Forwarded Message----- From: Barrows, Debi <debi.barrows(o)_town.barnstable.ma.us> To: 'taneilrogers@yahoo.com' <taneilrogers(d)yahoo.com> Sent: Thursday, April.23, 2020, 12:39:04.PM EDT Subject: FW: Residence to Asst Living t :. _See response:below. Thank you, _. Debi From: Anderson, Robin Sent: Thursday, April 23,2020 12:32 PM To: Barrows, Debi Subject: Re: Residence to Asst Living She first needs to show she has organized with the state including a mission statement. Once she has her documentation we can discuss her proposal and it may require spr(tbd), R Sent from my Verizon, Samsung Galaxy smartphone -------- Original message --:----- From: "Barrows, Debi" <Debi.Barrowsgtown.barnstable.ma.us> Date: 4/23/20 11:45 AM (GMT-05:00) To: "Anderson, Robin <Robin.Andersongtown.barnstable.ma.us> Subject: RE.Residence to Asst Living No she has a residential home she would like to turn into assisted living at 325 Megan Road, Hyannis Thanks, Debi From: Anderson, Robin Sent: Thursday, April 23; 2020 11:10 AM 2 : To: Barrows, Debi Subject: Re: Residence to Asst Living I'm not sure I understand the question. Is this a complaint? Sent from my Verizon, Samsung Galaxy smartphone -------- Original message - ------ From: "Barrows, Debi" <Debi.Barrows(cr�,town.barnstable.ma.us> Date: 4/23/20 10:44 AM (GMT-05:00) To: "Anderson, Robin"<Robin.Andersongtown.barnstable.ma.us> Subject: Residence to Asst Living Good Morning, I just received a call regarding the above, should she start with site plan? Thanks, Debi Barrows Office Manager Town of Barnstable. Building Department 508-862-4032 CAUTION:This email originated from outside of the Town of Barnstable! Do not click links, open attachments or reply, unless you recognize the sender's email address and know the content is safe! 3 i 71 Town of Barnstable Building Department - �of rti Brian Florence,CBO °s Building Commissioner BARN , : 200 Main Street,Hyannis,MA 02601 NAM 039. www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Approved: Fee: Permit#: '— HOME OCCUPATION REGISTRATION Date: 65cA s 2>q-: 5 Phone# Name: 2 C Address: Cl l t7� :� Village: Name of Business: , c — Type of Business: �b �� INTENT: It is the intent of this section to allow the residents of the Town of Barnstable to operateT hodme pupation within single family dwellings,subject to the provisions of Section 4-1 A of the Zoning ordinance,p , activity shall not be discernible from outside the dwelling: there shall be no increase in noise or odor,no visual Cn other than a residential use;no increase in traffic above normal > alteration to the premises which would suggest anything O residential volumes;and no increase in air or groundwater pollution- ® 0 After registration with the Building Inspector,a custom ary home occupation shall be permitted as of rift subject M -v following conditions: residential dwelling unit,located m < • The activity is carried on by the permanent resident of a singlefamily CI) C within that dwelling unit. q • Such use occupies no more than 400 square feet of space• and there 4 _-t 3 There are no external alterations to the dwelling which are not customary in residential bwldings, 2 0O zc is no outside evidence of such use. • No traffic will be generated in excess of normal residential volumes. M The use does not involve the production of offensive noise,vibration,smoke,dust or other particular rn 3> Q _ • matter,odors,electrical disturbance,heat,glare,humidity or other objectionable effects. C: C There is no storage or use of toxic or hazardous materials,or flammable or explosive materials,in excess M a of normal household quantities. • Any need for parking generated by such use shall be met on the same lot containing the Customary Home O Occupation,and not within the required front yard. z There is no exterior storage or display of materials or equipment Occupation,other than one van or one There are no commercial vehicles related to the Customary Home Occup • pick-up truck not to exceed one ton capacity,and one trailer not to exceed 20 feet in length and not to exceed 4 tires,parked on the some lot containing the Customary Home Occupation. No sign shall be displaye d indicating the Customary Home Occupation If the Customary Home Occupation is listed or advertised as a business,the street address shall not be included No person shall be employed in the Customary Home Occupation who is not a permanent resident of the dwelling unit occupation I am registering. I,the undersigned,have read and agre the above restrictions for my home ` (�'Cj �{' J Date: Applicant - ' Town of Barnstable � � 200 Main Street,Hyannis MA 02601 508-862-4038 fbs� 1� Application for Building Permit Application No: TB-19-2125 Date Recieved: 6/28/2019 Job Location: 325 MEGAN ROAD,HYANNIS Permit For: Building-Home Occupation Contractor's Name: State Lie. No: Address: , , Applicant Phone: (Home)Owner's Name: ROGERS,TANEIL Phone: (Home)Owner's Address: 325 MEGAN ROAD, HYANNIS,MA 02601 Work Description: CHERRY'S HOME CARE Total Value Of Work To Be Performed: $0.00 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 per 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: ROGERS,TANEIL 6/28/2019 Date Telephone No. Applicant Estimated Construction Costs/Permit Fees FTotalroject Cost: $0.00 Date Paid Amount Paid Check#orCC# ! PayTYPe /-.��{�Permit Fee: $35.006nanot9 s3s o0 Permit Fee Paid: $35.00 9THi� I5 NQ Town of Barnstable Building Department Brian Florence, CB 0 Building Commissioner 200 Main Street,Hyannis, MA 02601 www.townbamstable.ma.us Pre-application for Business Certificate Date (J�� ���`� Map ( Parcel Applicant Information Applicants Name.. Applicants Adr3ress Q ��L Email Addresses Telephone Number- ��J� S3�-41— Listed❑ Unlisted ❑ Business Information e Business? �'-{ 'L'_ _ mom_ '�`CC_- Yes No Nw ----------- Business is a registered corporation? ------------------------. Yes If yes Name of Corporation Does business operate under the registered corporate name? Is the business a sole proprietorship or homeomupation? ---------G No if yes then a Home Occupation Registration is rKaired—See Building Division Staff Name of Business C `P�{ �' \b m C-;o i Business Address cas 6L Type of Business Building Commissioner Office Use Only FwM__ ons p Building.Commission9 U12 b Date Clerk Office Use Only �r Town of Barnstable Building Department °pTHE TpKy Brian Florence,CBO Building Commissioner BARNSTABLE, « 200 Main Street,Hyannis,MA 02601 Muss. $ qj 1639. www.town.barnstable.ma.us pTfD NIA'1 h Office: 508-862-403 8 Fax: 508-790-6230 Approved: Fee: Permit#: HOME OCCUPATION REGISTRATION Date: �- 1 I �1 G e--i Name: -A C' ( A 5 Phone#:•3_i Address: , . S l � Village: Name of Business: ��( L A' �12MCI C,17),( �� Type of Business: b m C' ���i L L� Map/Lot: IJ INTENT: It is the intent of this section to allow the residents of the Town of Barnstable to operate a home occupation within single family dwellings;subject to the provisions of Section 4-1.4 of the Zoning ordinance,provided that the activity shall not be discernible from outside the dwelling: there shall be no increase in noise or odor;no visual alteration to the premises which would suggest anything other than a residential use;no increase in traffic above normal O C K residential volumes;and no increase in air or groundwater pollution. C C After registration with the Building Inspector,a customary home occupation shall be permitted as of right subject to the -0 OM -4 following conditions: < D O • The activity is carried on by the permanent resident of a single family residential dwelling unit,located D 6 within that dwelling unit. =1 rr • Such use occupies no more than 400 square feet of space. m M • There are no external alterations to the dwelling which are not customary in residential buildings,and there Cn C C 5; q is no outside evidence of such use. _ • No traffic.will be generated in excess of normal residential volumes. O = • The use does not involve the production of offensive noise,vibration,smoke,dust oT other particular z 0 .matter,odors,electrical disturbance,heat,glare,humidity or other objectionable effects. • There is no storage or use of toxic or hazardous materials,or flammable or explosive materials,in excess M D of normal household quantities. n • Any need for parking generated by such use shall be met on the same lot containing the Customary Home � C Occupation,and not within the required front yard. M D • There is no exterior storage or display of materials or equipment. _4 > O� There are no commercial vehicles related to the Customary Home Occupation,other than one van or one Z pick-up truck not to exceed one ton capacity,and one trailer not to exceed 20 feet in length and not to exceed 4 tires,parked on the same lot containing the Customary Home Occupation. • No sign shall be displayed indicating the Customary Home Occupation. • If the Customary Home Occupation is listed or advertised as a business,the street address shall not be included. • No person shall be employed'in the Customary Home Occupation who is not a permanent resident of the dwelling unit. 1,the undersigned,have read and\agre 'th the above restrictions for my home occupation I am registering. r�� Date. Applicant Homeoc.doc Rev.10/17 ;,TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION i Map Parcel SIP— Application # Health Division - -- 9 TOWN OF BPMSTABLE Date Issued ? Conservation Division 1 14,t 21 '+ 9: Application Fee �V V Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board—_- -- Historic - OKH _ Preservation/Hyannis Project Street Address Village 4"-N IS Owner A1d,v, < <q�P r 1'0 Address 0 "'Pq Q N(� l� �Q tv 0IS Telephone Permit Request 9,9 ct c e l ( 1 N t P r * --© Pre, Q r e Cc NJ, (o cl rSP T '004 sfu S Oklors - 'Whce MorescC� N QS Pa10of 6 (GCP Itvc)IOW,S Square feet: 1 st floor:_existing 1r IM proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuatio yy.60o'0Q,_onstruction Type_ l�O Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) Age of Existing Structure P 1 A? Historic House: ❑Yes 4o On Old King's Highway: ❑Yes ❑ No Basement Type: gkFull ❑ Crawl ❑Walkout ❑ Other Basement Finished Area(sq.ft.) Basement Unfinished Area (sq.ft) 1t (00 , 00 Number of Baths: Full: existingc new �J Half: existing new Number of Bedrooms: existingew 1 r Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: Gas ❑ Oil ❑ Electric ❑ Other Central Air: �es ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes �+� No If yes, site plan review# Current Use 51� Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name PQ L� �1V YvGi I o� _ -ZU' 0 N Telephone Number Address ?7(0 fy) License# C-S 10030 6 1�5�Pi Home Improvement Contractor# Email i (1�►'� 1 Y` C Pf 1�JC.�� Worker's Compensation ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE S nr FOR OFFICIAL USE ONLY APPLICATION # E r DATE ISSUED MAP/PARCEL NO. �.z t I � ! ADDRESS VILLAGE F OWNER fT i DATE OF INSPECTION: - � 1 j FOUNDATION �i FRAME INSULATION 's FIREPLACE ti ELECTRICAL: ROUGH FINAL A PLUMBING: ROUGH FINAL 4 GAS: ROUGH FINAL t FINAL BUILDING 4. DATE CLOSED OUT ASSOCIATION PLAN NO. I ;2 Y7ze Co=zompeaalfh rz,f Mas-vadlrisetffv Dj�paragmt o,f radk--aial Accidefd 6V O MaShFTWcTz Street as ozz ,AM 02111 tb`EY11�:7}7tISSLbf)Y1dI:Cd Warkers' CuDVensafi.-= u3-m-ance davit Bm-idersieuntractorsMec hmhers iICaI1 (�I�IIBtf�u Fleaseprint I ai lIY Nai7le ci j/s tet h Au- acne- Akre u an employer?CFtec�ilte appropxiafe bow ' _ of project(requseti)c I_ I am a empio yzs w-itx \_3 '- ❑I am a general con -a nd nd I 6- ❑New eonsfracfio4 empfzyees(R-2 a dfor pa�fi�e * I3ave!vre4�su_b-co3+Mi-fa._ l stad on the attached snev` 7- ❑Relnoclea-g �'.0 I•am a so-le p�pi;.et�arpastz!� �lae�sob-ca�ac{brs have s1`i-'_p aqd have no�ploy-,�s. , 8-.Q Demolium, Z,rnrS-i r fCCE='na is auy r.rr� amity employees mclbare wofkers g. ❑Builmg addition_ i�su once comp_ „ ran jN�a;�!�ers' coma_ lU� Electucal r �ad�t=o� reqused] 3. ❑ We are a corpora'd nand its epa� 3_❑ I ama gym:ok�E r doing afI V o ofcers brave exErdsed a�rir IL[I Pium s bsngrepairs or addition nys4 RNj WOZIMrs'tip`- aiexe¢tgfiou perT U'I. 1?❑Roafregairs ;nc�-as�re ie d_ t c-152,§?�}andwe have na e to owuAm& S-❑Other comp-ksmaurce mguired-11 n,s.�r3'��tt6s[C�?.L�bOs=1 of else�.►oo�t>t s�ctianbeLox<��m:�«ro�ev�c�o�aria�paTicfiamm�a� ' ����•,�„�,a.c�:aosn�t[r��d.^[�;n^"=�i�Ya=�i�siE�a�rs-3t��...,,-;r�_rs„��.Qs¢bmitar��xd�-�ti3n�Qsac=2 . a z•iv� 2c fvbm[�mt ffiaa�,;���5 _1ch ,c 'n of sob-com�rlc�an3-tatty ahniberumt.5=E Qti �a•� , e>�ivle�.7fti�sne cR,,*��*,,� �oF= m�X�tFsavidet�'r nnra�'t�sp_PeF abet. Fanf an aanyar Ser.�isprm�nir i��rsrkets?coQrpertsrdir»t irisrirar;�csvr }T�ripiny�ees $eToapisritc�pory cur e& s informrabiL 7�surznce Compaspiarse= J-1` C i �'�-C C. ( i '�L°_ fa,& -Policy- �� a56 � -� i ��i�ze_ io'b git Addreg� C Ci-,wstaf&ziP: (TMNI .d)(C'/ Attach a copy of the workers'caoapensationLpolicydecInration page-(showing the policy number and e:t�psation date). Fails to secusi-,coverage as requiredunder Section 25A o€M(M 0:1P can lead to the imposition of rs;mimal pens of a nne up to$1,5GUO and`or one year, sow as wen as civil penattiesis the fb=cra STOP WORK OPMERand a Ens o=up to 30-00 a dap a_sgaiust fbe violator- Be advised that a cape of this statement�he i tied ta tlie-Office of Imveslrgatims.of1he D.TA for coverage:'e mczti .1_do ftereay czdt5t wuLer the andpeuaMes arju that$ts&forwa#iou pmi&d abm of b;bus azad correct Pncnr f} cial rfis� £. ,T3a oat�Frrf� iFs2a, be scrl�apleterl by artnirn ajrcuaL rMy or To-%= FerLIIkUcense a Issuing Amf[ rity(C rcTe one): - L Baal d.af NwIth-1 BUTM; ui S.''frown Clerk 4.Ejeetrka.1 h speetoF 5.Phmibmg Lispecias 6.®thEr c'oatactP•erson: Phana� : -- -- -- - 6 BARNSTAOLL ,0� Town of Barnstable �t`0 MA'I a Regulatory Services Richard V.Scali,Interim Director Building Division Thomas Perry,CBO 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 1. ' L-1l�?�JP`�G 0104 ,as Owner of the subject property hereby authorize ;QC ' ����`{� ��f"�(�`(� to act on my behalf, in all matters relative to work authorized by this building permit application for: Elddress of Job) Signature of Owner We N Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. T:\KEVIN_D\Building Changes\EXPRESS PERMI'nEXPRESS.doc Revised 061313 f " r nra a.cn I IrwM I c la,aaucu Ha H IViw I I cn Ur UvrvnmA I IVI4 UIVLY ANU L;UNrttla NU HR9H 1,UYUN I rtt L&K I II-IL:A 1 t HULUtH. 1 HIti OERTIFICATE 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 PRODUCERy 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: Dowling&O'Neil Insurance Ag HO No,E><t,508 775-1620 FAX 9731yannough Rd,PO Box 1990 E-MAIL A/c No:5087781218 ADDRESS: Hyannis, MA 02601 INSURER(S)AFFORDING COVERAGE NAIC# �508 775-1620 INSURER A:National Grange Mutual Insuranc INSURED INSURER B:Associated Employers Insurance Meagher Construction Inc.Timothy Meagher INSURER C. 776 Main Street , INSURER D: Osterville,MA 02655 INSURER E: _ INSURER F- COVERAGES CERTIFICATE NUMBER: 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 CONTRACTOR 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. INSR TYPE OF INSURANCE ADDL UBR POLICY EFF POLICY EXP LTR INSR WVD POLICY NUMBER MM/DD MM/DD/YYY LIMITS A GENERAL LIABILITY - MPT125OG 0/16/2015 1011612016 EACH OCCURRENCE_ S1,000,000 ! X COMMERCIAL GENERAL LIABILITY PAMAGF T ERa NToccu D nce S500,000 CLAIMS-MADE 51 OCCUR MED EXP(Any one person) S 1 O 000 PERSONAL&ADV INJURY $1,000,000 p� GENERAL AGGREGATE 52,000,000 GEN1 AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG S2,000,000 POLICY DJECT PRO LOC S AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT i Ea accident S ANY AUTO BODILY INJURY(Per person) S ALL OWNED SCHEDULED BODILY INJURY Per accident S AUTOS AUTOS ( ) NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS , I Per accident S S j !UMBRELLA LIAB - OCCUR EACH OCCURRENCE S k Hi EXCESS LIAB CLAIMS-MADE AGGREGATE S i DED RETENTIONS S B WORKERS COMPENSATION WCC5050054422015A 6/23/2015 06/23/201 X TQ Y I IMrr OTH- AND EMPLOYERS'LIABILITY Y/N I ANY PROPRIETORIPARTNERIEXECUTIVE E.L.EACH ACCIDENT _S100 000 OFFICE RIMEMBEREXCLUDED? FNI N/A (Mandatory)n under E.L.DISEASE-EA EMPLOYEE S1 00 000 It yes,DESCRIPTION OF OPERATIONS below E.L DISEASE-POLICY LIMIT S500,000 { DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) Certificate holder is named additional insured for general liability. Insurance coverage is limited to the terms,conditions,exclusions,other limitations and endorsements. Nothing contained in the certificate of insurance shall be deemed to have altered,waived,or extended the coverage provided by the policy provisions. CERTIFICATE HOLDER . CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE I THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN _ ACCORDANCE WITH THE POLICY PROVISIONS. f AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010/05) 1 of 1 The ACORD name and logo are registered marks of ACORD #S160683/M160682 LS1 Lrcense or r �stratron valid for tndrndul-use onl + • ��,�amcm�.axu�eall�a�Clli�i�.t�ac�rueff3 � � � Y-- Office of Consumer Affairs&Business Regulation before the exprration date$hf foundreturn to e i Z�] OME IMPROVEMENT CONTRACTOR °= Office ofnConsumer Affairs and Baseness Regulations_ egistration 162938 Type 10 Par<k Plaza S e 5130 Expiration = 4l27/2017_ DBA Boston; OZy J64 ' MEAGHER BROTHERS.CONSTRUCTION M1 fl MICHAEL MEAGHER'JRz `97 EMERAL-D.LN . 1,E . .� of w'� oiit�stgnature - .MARSTONSMILL,MA 02648 " r'. Undersecretary ,t -Bull. ' of any use group Which st rioted 0 Unre.. Massachusetts-Department of Public Safety contain,less.than 35,000 cubic feet(99'lm3)of Board_of Building Regulations and Standards enclosed space. . Construction Supen-isor - License:CS-102260 , r iaN ? , MICHAEI:S MEA,�]HER,JR 97 EMERALD LANE f #.' Marstons Mills NJEI 02648 Failure to possessa,cuaent edition of.the Massachusetts State Building Cod'e.,is cause for-revocation:of this license. For UPS licensing information visit www Mass.Gnvj0PS Expiration Commissioner:' 11/0412016. ' l r TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map I Parcel ZS l0 T '.,M O BARNSTABLE Application # Health Division F'j ': Date Issued /4-��l-/S Conservation Division Application Fee _ Planning Dept. .,. Permit Fee �d 3 • �.� Date Definitive Plan Approved by Planning Board U �,T'NUi''` Historic - OKH _ Preservation / Hyannis Project Street Address 3.2 S_ M f-5 A"d Village JA 4 Owner k T' o,oY J-e C t L.13,e&4-D Address 3 aS� e9' P i-+A1 Nis' Telephone S-W ol-06 7 /VV S / Permit Request �n 0V`G IS h eC�T/?�zi� +- l NS tcLh-1-i®� 7- rZ0(e!J4 ,0 .-e I. E'hs T-i &k4 e, ib 4 e e-a r� / S a /� A-g� V O S 1 Le 4&- ( e r,N 0 �� r Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District ,c Flood Plain Groundwater Overlay Project Valuation�° �'.Soy 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: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑ Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ 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 APPLICANT INFORMATION = (BUILDER OR HOMEOWNER) Name A'(L, L A-t4 f�-t A Telephone Number 791 d-(o -77 Address ll• L e-wty l)r- License # CS P4 6 6-1 7 S C•-lghJl "e4 C�a3 7 Home Improvement Contractor# ! ;L? Email LA-u`I./h X 17 (P H6)v ,<o,*"Worker's Compensation # K;, LAb 3 1 s31 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO ) S-r&4kcY'/0d ?Ju tl rgsTeA- ON S z SIGNATURE DATE F' l Q FOR OFFICIAL USE ONLY r APPLICATION# r ; E , DATE ISSUED MAP/PARCEL NO. r. ADDRESS VILLAGE OWNER 9 DATE OF INSPECTION: 1 FOUNDATION t FRAME INSULATION t` FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL F i FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. I Client#:34309 MULTISTA ACORD.. , CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) 10/14/2015 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: Maria Barnowskl Starkweather&Shepley PHONE 401 435-3600 FAX 401-431-9326 PO Box 549 A/C,No Ext: AIC,No ADDRESS: mbarnowski@starshep.com Providence,RI 02901-0549 INSURER(S)AFFORDING COVERAGE NAIC# 401 435-3600 INSURER A:American Safety Insurance INSURED INSURER B:AmGUARD Insurance Company 42390 Multi-State Restoration of Cape Cod P.O.Box 2210 INSURERC:Hartford Ins Group 19682 Mashpee,MA 02649 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 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 CONTRACTOR 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. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LTR INSR WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS A GENERAL LIABILITY EPK106790 1/01/2015 01/0112016 EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES Ea occurrence $50,000 CLAIMS-MADE 1:9 OCCUR MED EXP(Any one person) $5,000 X BI/PD Ded:5,000 PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000 POLICY PRO- JECT LOC $ C AUTOMOBILE LIABILITY 02UENQT4762 - 1/01/2015 01/01/201 COMB NGLELIMIT Ea accidentdent) $1,000,000 X ANY AUTO a- �, BODILY INJURY(Per person) $ - ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE AUTOS Per accident $ $ UMBRELLA LIAB �CLAIMS-MADE EACH OCCURRENCE $ EXCESS LIAB [� AGGREGATE $ DED RETENTION$ $ B WORKERS COMPENSATION R2WC639531 7/16/2015 07/16/201 X WC STATU- AND EMPLOYERS'LIABILITY OTH- ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N ER OFFICER/MEMBER EXCLUDED? Fy N I A E.L.EACH ACCIDENT s500,000 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $500 OOO If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $SOO,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) RE: 325 Megan Road,Hyannis,MA 02601 CERTIFICATE HOLDER CANCELLATION Town of Barnstable SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 200 Main Street ACCORDANCE WITH THE POLICY PROVISIONS. Hyannis,MA 02601 AUTHORIZED REPRESEENTATIVE^&M^L� ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010/05) 1 of 1 The ACORD name and logo are registered marks of ACORD #S740661/M653583 SSB MULTI-STATE RESTORATION, INC. FIRE* FLOOD*WIND * SMOKE*HURRICANE*VANDALISM Fed ID#050515889 CONTRACTORS REGISTRATION#140427 AUTHORIZATION TO PERFORM SERVICES AND j DIRECTION OF PAYMENT herein referred to as "Customer",authorizes MULTI-ST E RESTORATION,INC.,herein referred to as "MULTI-STATE",to perform any and all necessary cleaning and construction services on Customers'property at: yuiz jL.vi f fi/ :-. , Telephone: and with respect to items that need to be cleaned at a remote location,to remove and clean such items as necessary. Customer authorizes 2 C&�4 o �- Al Zinn Insurance Company,herein referred to as"Insurance Company",to directly and solely pay MULTI-STATE. If for any reason the check should come to be or be made payable to the Customer, Customer then agrees to pay MULTI-STATE immediately upon receipt of the check from the insurance company. In order to expedite payment to MULTI-STATE, Customer hereby appoints MULTI-STATE as attorney-in-fact,authorizing MULTI- STATE,to endorse Customers'name,and to deposit Insurance Company chec drafts for MULTI-STATE services. Customer agrees to pay Custome eductible in the amount of$ that applies to this c If the loss is not covered by insurance,Custom a to to amount to MULTI-STATE upon receipt of the invoice. Si natu of Owner It is my understanding that the services to be performed by MULTI-STATE will be limited to those,which are authorized by my Insurance Company. (U(✓ .c71n .c9,n Insurance Company Name Policy Number Customer agrees that MULTI-STATE is working for the Customer and not the Insurance Company or agent/adjuster. Additional remarks: r Ahay. thi pcument and com ely understand and agree to same. Date Printed Name P.O. BOX 2210•MASHPEE, MA 02649 .866-921-9111 •FAX 774-238-4422 ,q , Ile Comm,omvealth o,f-Vassachusetts Deperlrkneirt o,f rndushialAcciderris t Y Ojfwe-o,f rnvestiOtions y 600 Washington Street Baswn,MA 02111 wrvm nrasmgovIdia Workers' Campensation Insurance davit:$mlder/C,ontractursMectricians/Plumbers Applicant Information Please Frint fed Name(lusiaess10rganinfionMiRv dual Ll l_T! S'T/4-1`� STD �''�•' Address 0 N I C O L e-r -FA L.tJ l9'Ld City/State(;- � (JC�e (�'1 Phone iu 8 77- 3 3 3 3 Are you an employer?Check the appropriate box: Type of project(required): I.Z I am a employer with. 4 ❑I am a general contractor and I 6. ❑New construction employees(fulf ac&or part-time).* have hired the sub-contractors 2.❑ I am a sale proprietor or partner- listed on the attached sheet; 7. ❑Remodeling slip and have no employees. . These sib-contrac#ors have g- J§Demolition working forme in any capacity employees and have workers' [No v;orlaem, camp.insurance comp.insuranv.l 9. ❑Building addition required-] 5. ❑ We are a corporation and its 10❑Electrical repairs or additions 3.❑ I am.a homeoumer doing all work officers have exercised their 1L❑Plumbing repairs or additions myself-[No workers'temp- right of exemption per MGL 12.❑Roofrepairs insurance required.]Y c.152,§1(4h and we have no employees.[NowoAmrs' 13.❑Other comp.insurance required-] 'tiny appKcznt&zt cbecU box R Ott also fillo=the secuicabelowshuning ffieuwaaere compenmflaupalicyinform2 ion. I homeowners who submit ibis affidnft huff-tin;they ase doing ag war=1 d=hire outside contiactars Est submit a new a$ida indicating.sudL ICanuwtors Ib mt eheckthis boa mast attached as additional sheet shoRiag the nameof&a sub-canuzatoa sod state whether ar not those eadtieshwe employees.Ifthesub-contzxcLmeshave employees,they mnrstpmuride their workm'comp.policy number. I out air emriplrmyer fleatis pro�zding iv©rkets'conipe rrsrrharr irrszrrance fur�rl*enzpFn}�es Beloit=is ilia paUcy curd jola the informaliomz Insurance Company Name: �M co Policy t4 or Self-ins.Lic.* P- oZ V3 C lo 3 9 S 3 / apiralion Date: -7--/b-l 6 Job Site Address 3 a r�f cj A-.► 14 City/St,.eWZsp: h-�J N lS' Attach a copy of the workers'compensation policy declaration page(shoving the policy number and expiration date). Failure to secure coverage as required.under Sec ion 25A of MGL c 157 can lead to the imposition of criminal penahies of a flue up to$UOD OD andlor arje-y-ear imprisonment,as well as civil penalties.in the fonn 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 maybe forwarded to the Office of Irnrestsgations ofthe DIA,for insurance coverage verificafton. I mla ImenRby ccerfr azardff tha pains and,pona�zs o:f gerimy flratf�lre irmformeafimr pt or rled abm s is b ire and correct Sitmature- G Irate: Phone i;�` 7 p Y S 6- :7 . F or Town: Permitff&ense# ng Authority(circle one): ard of Health 3.�sIing Department 3.CityHown Clerk 4.Electrical Inspector S.Plumbing Inspector her act Person: Phone#: ormation and lastructions , Ma c&a husetts General Laws chapter 152 regm all employers Yn prffvide workers'compensation for ilieg employees. pm suato this srte,an Ioyee is&Entki as"_.every person m the sravice of another ceder any contract of hire, express or iMplied,oral or written." An e2 player is deed as"an in ividII.aI,pmtaersbip,association,corporation or other Iegal entity,or any two or more of the engaged.gaged.ina joint enterprise,and inclnding the legal representatives of a deceased employer,or the receiver or trustee of an individual,pa t3mship,association or other legal entity,empl°Ymg employees- However the owner of a.dwelling house having not more than three aPemeats and who resides therein,or the occapant of the - dwelling house of another who employs persons to do maintruan w,construction or repair work on such dwelling house or on the grounds or budding appurtenaIIt 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 or license li permit tooperate a business or to construct buildings ut the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance.cove)cage required," Additionally,MCrI.chapter 152, §25C(7)states-Neither the commgnweala nor airy of its political subdivisions shall enter into any coat a.ct for the perfozmmaw,ofpnbho wont u off acceptable evidence of compliance with the in cLTran ce. requirernents of this chapter have'ieen presented.to the contacting authority_" APplicaats Please fill out the workras'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sul-contractor(s)name(s), address(es)and phone numbers) along with their certiacate(s)of H=ance. Limited Liability Companies(I.LC)or Limited Liability Partnerships(LLP)vn&no employees other than the members or partners,are not mqui ed to carry wOIkers' compensation i asuranCe. If an LLC or LLP does have employees,a policy is regnu-ed. Be advised that this affidayif maybe submit-ti--d to the Department of Industrial Accidents for confirmation of insorance coverage- Also be sure to sign and date the of trdayit The affidavit should be ret amed to the city or town that the application for the permit or license is being requested,not the Department of Lndmsft-.Lal A=den s. Should you have any questions regarding the law or ifyou ate required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-msmed companie$shouId enter their self-fi so aT,ce license number on the appropriate line. City or Town OffidaLs t Please be s¢re that the affidavit is complete and prfi tedlegiibly. The Department has provided a space at tine bottom of the affidavit for you to fD1 out in the event the Office of Investigations has to contact you regarding the applicant Please be sure to fill in the peunit/Iicense number which will be used as a reference number. In addition,an applicant that must submit=multiple permitllicense applications in any given year,need only submit one affidavit indicating con ent policy fi fo=ation Cif necessary)and ender"job Site Address"the applicant should write"all locations in (�Y or. town)."A copy of the affidavit that has be a officially stamped or named by the city or town may b e provided to the applicant as proof that a valid affidavit is on file for fdm-e permits or licenses Anew affidavitmust be fM1ed of t each Y ear.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venfise ete this affidavit: (Le. a dog license or permit to bum leaves etc_)said person is NOT required to comp' The Office of Investigations would at to thank you is 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 nrnber e C-aMMM tbE of Massa ahnsetfs Degaiiment Gf1i&nstcW Accidents - Gffice of jhvesfrgatio= �Q•4�ashin�tan Stre,�t B.r?st�&fA E�11F TeL#617-727-49W=t 406 W 1­8W-MASSAFE Fax 9 617 727 7749 Revised4-24-07 .,mas.5_gW JJ ffice of Consumer Affairs s irs&Busiu s Rac . F > won ME IMPROVEMEN:T'CONTRACTOR s egistration 1;40427 TV, Ex P•iration 10/15/2015 MULTI-STATE,RESTO SuPPIemePt RATION INC.CAPE COD RICHARD LAURIA ` t P: 0.Box 2210 MASPHEE,MA 02649 � Uudersecreta " L icense or registration valid for individul use-only. before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation.• 10 Park Plaza-Suite 5170 Boston,MA 02116 i i Not valid without signature i Massachusetts -Department of Public Safety *Board of Building Reguiations and Standards Cons._.._ o_.__--n-__I o 2 r.�___n__ �.uu�u u�iuiii �uirci vnv� i ax�r auwy License: CSFA-051784 r�.s RICHARD D LAIIIA _�_, ram' .. 1 LEAH DR Rockland MA 02370 r Expiration 04/01/2017 Commissioner i wooZ� S/V -7 �1 Sr TV .y a zwt S ; � e�"�.'���aX'��''es� '�3 d"�„'�`�.a ,'�" � tt-•• `c� %5 't a� .�"'�tG..� � _ z, r i �� �-1 1�. - t-R,.ru,� .i� Via.X; 'W 'A. „� .. � 1i 36-5 u+ - I g o-7 -' w ��1 IN CERTI R ( ED PLOT L O C A r 1 O N: H 5�.9�c%V CS r : S C A L E: r--� _ EnATE REFERENCE i O �V Lf�.�lD G Ou�2'T pLAlV 'r �7p�� w:. '.'.{. DATE I HEREBY CERTIFY THAT -THE BUILDING REG. LAND SUR EY0R SHOWN ON THIS PLAN 15 LOCATED O N T HE G ROUND AS SHOWN HEREON A N D THAT IT �o�s CONFORM TO THE Z ON IN G BY - LAWS OF THE TOWN O-F ���,�I" OF4ft 6E WHEN C ONSTRUCTE D. ��°� 4 `\� F77 GEORGE N\ LOW,JR. S BARN5TABLE SURVEY CONSULTANTS, INC C, 5TE �O WEST YARM0UT' H MASS . r t ,,gn_,.,.e.,, .n y_ri � 7 �� Y .\ F 4;/ �.� 3�`' � � < D; tS�'w.l.q y,.O 8 ,�7 n .� 4 `p�"'.1 �...P.a 4' ° a r .. 1 J l �� '�, �� 1 � �� _� Article Preview: Hyannis fire displaces family of four- capecodtimes.com- Hyannis,MA Page 1 of 3 73-172-94-169-170-2669-2322-2647- Search St Hyannis 740 e-edition I subscribe I newsletter I deas CAPE SOD TIMES tl angieQs list r Register Here to Read This Article- FREE! HOME NEWS SPORTS BUSINESS ENTERTAINMENT OPINION LIFE -REGIS(ERIII-F&ASSIFIEDS JOBS AUTOS REAL ESTATE FREE Registered Members of p f� Thu,September 17,2015 v Oa'_T*&CO ' P6ml&hlt.�A IU afff�!g"SHARKS 'I ACK 1:Qifft(09'*.MQntIAPr174*XhM: BUSINESS SERVICES I EXPLORE H per month from all departments-at any First Name r--. NEWS NOW Sled in Hytime,from.anywhere Va4goagp/neyard Hospital president td-egbName Lyich w n't extend contract with Barnstable Already a member? Print Subscribers, HYAN NIS Click here to log in. Click here. ----- ----•------ Hyannis fire displaces family of Pick Passwordpur Confirm Password Blaze began in window air-conditioning unit What started as a spark from an air-conditioning unit causes substa nIP to a ozso�to„v house. Privacy Policy n0 thanks COUPON OF THE WEEK t, x Limelight Deals eCoupons Consumers love coupons.Your business 1 belongs in the Limelight! Cape Cod Media Group SEE ALL ONLINE TODAY MORE» . F + 171 p n l �f j. III TOP JOBS Housekeeping Supervisor ` Brewster,Massachusetts Ocean Edge Resort &Golf Club Maintenance Mashpee,MA,USA Cape Cod Times Classified Ads Jeanne Ciliberto holds her son's soot-covered vanity letterjacket,which was damaged along with many other items in afire at her family's Hyannis house Tuesday night.The family of four will have to find a place to live for the next Customer Service Representative few months while their house is rebuilt.Ron Schlaerb;Cape Cod Times POcasset,Massachusetts Glass Expansion By K.C.Myers Boston Based Group Sales Manager kcmyers@capecodonline.com Brewster,Massachusetts Ocean Edge Resort &Club on Cape Cod Posted Sep. 16,2015 @ 8:41 pm Updated at 8:42 PM More Top Jobs HYANNIS—The firefighters saved Jeanne Ciliberto's sneakers,so she can still go running and to her job as gym teacher at Hyannis West Elementary School. But the teacher lost her home in a fire Tuesday night,leaving her family of four without most of their belongings or a place to live. The smoke detectors inside[325-megan'Road--went of,at about 10:50 p.m.,waking her up along with her two teenage sons and her husband,Tony,she said. They were able to escape from the burning;house.But 14-year-old Joey's room,where the fire started,must be gutted and rebuilt,she said. 3 of 3 Premium Clicks used this month PRINT+ONLINE SUBSCRIBER ACTIVATION I REGISTER SUBSCRIBE http://www.capecodtimes.com/article/20150916/NEWS/150919480 9/17/2015 Article Preview: Hyannis fire displaces family of four - capecodtimes.com - Hyannis, MA Page 2 of 3 Although the family has insurance,it will be several months before they can return to the TOP HOMES • Buzzards Bay,MA-$495,000-Luxury Her son's new$400 bicycle melted,she said. waterfront condominium at Aptucxet. Unobstructed views of the Cape Cod canal from The family awoke to the sound of smoke detectors,which frequently malfunction,Ciliberto this end unit in the choicest waterside location said.Her husband got up to shut them off,but then Joey came running out of his room, of... ..................................................................................... Behind him,his room glowed red,she said. Provincetown,MA-$899,000-Enter through the front door of this Contemporary Cape and be His window air-conditioning unit had arced,and the spark caught the window drapes, amazed at the view!A wall of glass overlooks Shank Painter Pond with its lush... When the firefighters arrived,flames could be seen coming out of a bedroom window, """""""""""""""""""""'More Top Homes Hyannis fire Capt.Mark Storie said. The fire was under control in about 30 minutes,but the house had substantial damage,Storie "The neighbors were wonderful,"Ciliberto said."They gave my kids clothes.Someone gave us money." Uiflagst fully •�4,3fBfiFlvs.lGtl.., I ON The Cilibertos stayed in a motel Wednesday night courtesy of the Red Cross.But they will need to find a place to rent and get clothes and other needs in the short term. es 11' —Follow K.C.Myers on Twitter:old kcmyerscct, M ' Comment or view comments Ads by Adldade i More Articles and Offers t. More videos: Discover a breakthrough Try this quick,healthy& Diabetics:Do This 1 Thing Read about{the new policy - f in your home viewing delicious SlimFast recipe: Before You Eat Sugar which reduce your onexperience with these Winter Warmer Mocktail. electricity bill and Increase state-of-the-art TVs. property value-forfree. STAY INFORMED Email Sign Up Today NewsLetter Sign up for our newsletter and have the top headlines from your community delivered right to your inbox. Nemcda You Decide Who Won the Debate! Vote Here .................................................................................... Fiorina:'Women Heard Clearly' What Trump Said About My Face ................................_..........,........................ New Probiotic Fat Burner Takes GNC by Storm ................................:................................................... Ben Carson Credits Presidential Campaign to This Brain Pill Carson Shocks America-Credits Presidential Campaign to One Pill .................................................................................... 68 Year Old Looks 31:You Will Not Believe Her Simple Trick ..................................._........ Two Simple Steps to Remove Bags and Wrinkles From Your Eyes ......................................................... Americans Urged to Search Their Names Before Site Gets Taken Down ........................................................... What's This? ERROR: Macro section- content/rightrail/sections/pgoa-recipe is missing! TOP CLICKS POPULAR Bee-Hive Tavern getting a new owner, name Sep.14,2015 �1C5hicck�-5fil-A plans Hyannis location 3 of 3 Premium Clicks used this month PRINT+ONLINE SUBSCRIBER REGISTER REGISTER SUBSCRIBE http://www.capecodtimes.com/article/20150916/NEWS/150919480 9/17/2015 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Ma � � - i #Parcel Permit p � Health Division �(113/.� �' �� �' � Date Issued Conservation Division J zoo — Fee j� 3, 02( Tax Collector .. U I S1�°Pi � ' 6'6 Treasurer �De—e-�, -�/�I��Z��f INSTALLED IN COWILK . WITH TITLE 5 Planning Dept. - ENVIRONMENTAL CODE Date Definitive Plan Approved by Planning Board TOWN REGULATIONS Historic-OKH Preservation/Hyannis Project Street Address ` 73 Village 00,74 i , 1 Owner Address 1;7rl,' Telephone Permit Request ,/8`-4-4'����4/J�/�D.2._ r"— IJ.F]�� /,�?4`i/�G� r�c2i►^�'' Square feet: 1 st floor:existing proposed 2nd floor-exrstiltg p sed" Total new �- Valuation i Zoning District Flood Plain Groundwater Overlay Construction Type v 6 U 0 Lot Size Grandfathered: ❑Yes No If yes, attach supporting documentation. Dwelling Type: Single Family '14 Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: Cl Yes No On Old King's Highway: ❑Yes ❑No 'basement Type:Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) _ Basement Unfinished Area(sq.ft) Number of Baths: Full: existing L new Half:existing new Number of Bedrooms: existing_ new Total Room Count not including baths): existing 3 new( g ) g � _Z First Floor Room Count Heat Type and Fuel:`KGas ❑Oil ❑ Electric ❑Other Central Air: ❑Yes No Fireplaces: Existing _ New — Existing wood/coal stove: ❑Yes ><No Detached garage+-a-existing-mew size Pool:❑existing ❑new size Barn:❑existing ❑new size Atiached garage:❑existing ❑new size Shed:O existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes,site plan review# Current Use Proposed Use BUILDER INFORMATION _ ' r Name Z� G;f Telephone Number dg" 7 7$� c>=�6' 1 Address 2 S z a[ r- � �� License# (11(a( 9 LALL 4n/I! S lyl>aCS 0 d01 Home Improvement Contractor#Worker's Compensation# - -71 � OONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TOTURE DATE �� ®•� FOR OFFICIAL USE ONLY f PERMIT NO. - r DATE ISSUED e MAP/PARCEL NO. ADDRESS VILLAGE� OWNER DATE OF INSPECTIO s - FOUNDATION © 1 FRAME V11 _ INSULATION", FIREPLACE r ' ELECTRICAL: ROUGHy = = FINAL b PLUMBING: ROUGH" 17 :' FINAL _ GAS: ROUGH "" FINAL _ FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. t a i • RDJFCT COST W(ORKSHFE7 ESTIMA TFO P Value LIVING SPACE / square feet X S1151sq. foot= (high end construction) (above average construction) 1 square feet X S961sq. foot' e L .square feet X S571sq. foot (average construction) = square feet XXSZ51sq. foot= GARAGE (UNSHED) square feet X SZOIsq. foot= PORCH square feet X S151sq. foot= DECK "- square feet X S??1sq• foot= OTHER 4FY Total Estimated Project Value ' M MAScheck COMPLIANCE REPORT Massachusetts Energy Code Permit # MAScheck Software Version 2 .01 Release 3 Checked by/Date CITY: Barnstable STATE: Massachusetts HDD: 6137 CONSTRUCTION TYPE: 1 or 2 Family, Detached HEATING SYSTEM TYPE: Other (Non-Electric Resistance) DATE: 4-18-2001 COMPLIANCE: Passes Maximum UA = 97 Your Home = 95 Area or Cavity Cont. Glazing/Door Perimeter R-Value R-Value U-Value UA -------------------------------------------------------------------------------' CEILINGS 414 38.0 0.0 12 WALLS: Wood Frame, 16" O.C. 424 15.0 0.0 33 GLAZING: Windows or Doors 107 0.320 34 FLOORS: Over Unconditioned Space 414 25.0 0.0 16 ------------------------------------------------------------------------------- COMPLIANCE STATEMENT: The proposed building design described here is consistent with the building plans, specifications, and other calculations submitted with the permit application. The proposed building has been designed to meet the requirements of the Massachusetts Energy Code. The heating load for this building, and the cooling load if appropriate, has been determined using the applicable Standard Design Conditions found in the Code. The HVAC equipment selected to heat or cool the building shall be no greater than 125% of the design load as specified in Sections 780CMR 1310 and J4.4 . 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Geller,Director Building Division Elbert Ulshoeffer, Building Commissioner 367 Main Street.Hyannis MA M601 Office: 508-862-438 Fax: 508-7 90-62r0 Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 147U requires that the 1-=onsnucti=alterations.renovation.repair.modernization.conversion. improvement.removal.demolition.or corm action 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 4acert to such residence or building be done by registered contractors.with certain exceptions.along with other requirements. Type of Work-� /2,-- Estimated Cost Address of Work— Owner's Name: /7 //0 �J 1`/ !_ Date of Application: c I hereby certify that: Registration is not required for the following reason(s): []Work excluded by law []Job Under S1.000 []Building not owner-occupied []Owner pulling own permit Notice is hereby given that; OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A. SIGNED UNDER PENALTIES OF PERJURY I hereby a Iy f ),permit as the ent o owner. Date Conr Name Registration No. OR Date Owner's Name OTBOARD OF BUILDING REGUO TIO&N License: CONSTRUCTION SUPERVISOR z Number CS 0101.61 i Expires:.09/30/2001 Tr.no: 16291 F` Restricted To: 00` f JOH" LEBOEUF .35 Fii SS PINE RD_.. ._t .•w HYANNIS, MA 02601 ' . Administrator. - 777 ([�\ Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registration: 117872 Expiratloni 12/12/2002 } Type: INDIVIDUAL j i JOHN A.LEBOEUF 1 JOHN LEBOEUF 35 PRINCESS PINE RD o HYANNIS,MA 02601 Administrator Asse�sap and lot number �j :.: SEPTI�C,SYSTE'e7r.l �.T BE ... IN STA L L E D. I N, GGh-2F LIANC� WITH A TI��.!" I I S?�}TE Se"a e'`Permit number ............ ........ �3 g ; SAf�ITARY CJ. € ARP, TOWN r..3 REGULATIi�N$ ' T"ET°� a TOWN- OF BARNSTABLE BBBBSTODLE; i ?" � ' e3' AG VASIL 3q 3 t -} NUI rD INSP.ECTOW o war a -.4 .1 c.3 , -i APPLICATION FOR PERMIT j.0 ..... .��. ............. .................t'J..`..L.. ....................... ............... fQ c, TYPE OF"CONSTRUCTION .............................� ' .................................................. ........ .................E f ........ .2- ...................:19 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location .... .. . t4 ...... ............... ,c..... ........... ............... ..............,. ............................ ............... Proposed Use ...d. Zoning District ........�..L.................................................Fire District ........I...... ..... Name of Owner .A. . . ............Address . c`''2���' .... .. k L f Nameof Builder ....................................................................Address ............................................................................ t t c f r Nameof Architect ..................................................................Address .................................................................................... Number of Rooms ..................�.............. .............................Foundation ........................................ Exterior ..............0 ..........$.�..��.A...�=.............Roofing ...........4�......P...... `�.`.......................... ....... Floors ..................................4...................................Interior �v, � t Z.............. ........................................ Heating ............ .........................(........................Plumbing ...............I......... ............ ....�............................... Fireplace l ......Approximate Cost G�V v DefinitvGe Plan Approved by Planning Board ________________________________19________. Area /b �' ._ .......................................... Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ....v`... .........l...... .............. Smith, J. K. at OilI one story ...... . Permit'for .................................... , ,single family dwelling ......................................................................... ;r Megan Road Location ................ PA.................. Hyannis ....................................... J. K. Smith Owner ................................................................... frame Type of Construction .......................................... ...............................................................:�............. tPlot Lot ................................ f 6� December 2 I Perm it5ebra nted ... .... ............... ....ig 75 Date Inspectio n .11 T .... ..... . . ..Date Completed ...... ... ............... 19 '"PERMIT"'REFUSED N ........................;..................:................... 19 ...................... .. .............. .... ...................................... L ..................... .................................................... ....................................................................... ............................................................................... Approved ..........................................t..... 7 9 ................................................................................ .......... f +� 9 v o � o e oT B Z IN Q N /�SOZ oT CERTI FIE PLOT PLAN L O C A T I O N: H 5�'�J�/.V 4.55 5 C A L E: �!-3p" D A T E 7S REFERENCE ��ivl� �o� 8 ,� D A T E I HEREBY CERTIFY THAT THE BUILDING REG LAND 5URVEYO !R SHOWN ON THIS PLAN 15 LOCATED ON THE GROUND AS SHOWN HEREON AND THAT IT CONFORM TO THE Z ON IN G BY - LAWS OF THE TOWN OF l�LShOFR9 W H E N C. 0 N 5 T R U C T E D ° GEOr.GE R � C> LOW,JR. �Jg; • ,Sj � A BAR NSTABLE SURVEY CUNSULTA NITS, INC . WEST YARMOUTH MA55 SU R'0 i Assessor's map and lot number ..............................2-7............. . Sewage.Permit number F w ��FTHET��y TOWN OF BARNSTABLE BASB9TAIILE, � + "6 9 - - . BUhLDING 4 INSPECTOR' a_^_S2 APPLICATIONFOR PERMIT TO .....................................................................`.................:..................... ION TYPE OF CONSTRUCT 4 ........... ......................... TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location .''. �� Proposed Use t,_,. * / t Zoning District .........'.'.�aal..�...................................................Fire Distract .............. .''L�-. .... ............................. Name of Owner .........` .....`...!...`........ ..`....`.. ..........Address .................. ...:..................... r_ ' Name. of Builder ................................ ..............Address...................... ..................................................................................... j c Nameof Architect ..............................................._...................Address .................................................................................... Ccc it Number of Rooms ................. ..........................................Foundation ................ ......................................... Exterior C-'( 4.n L" ..Roofing A..? v.... Floors � c= Interior .............. ..Z �l Y` Heating ..................................... ..�........................Plumbing ...............I......... .. ..... ..... ...../......................... Fireplace ..................................................................................Approximate Cost .............................................................. '...... Definitive Plan Approved by Planning Board ---------------_---------------19--------. Area l '........................... Diagram of Lot and Building with Dimensio s- Hee /' G SUBJECT TO APPROVAL OF BOARD OF HE LTH • 3a o it u 4y I hereby agree to confo o all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ....v�.......` fir".:..... ......... h Smith, J.- Ke: A=291-256 18111 - one story No ................. Permit for .................................... single family dwelling ................................................. ...... 62 ;S Megan -Road Location ...... ........................* ................................. . .........................Hyannis ................................. J.' K-0 with Owner .................. ..... .. ................................ frame Type of Construction .......................................... .............................. ................................................. #8 Plot ............................ Lot ................................. December 23 Permit Granted ......................P.................19 75 Date of Inspection ............... ........19 Date Completed ............ .........................19 .REFUSED...................... .......................... 19 ................. ......................................................... .............. .......... ................................................... .............. ............................................................... Approved ............................ . .................. 19 .......................... ............. ...................................... . ......... ...... .................. ........................................ � y z FT I mac. Igx a Ro�1;o,✓ - 1 f 7` V s7t .a-0/ I � I � .. , _ rr' . P • Oe• G uA? 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