HomeMy WebLinkAbout0011 PERIWINKLE DRIVE !� �E,e%Gtli N�t'C L" 17�'
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Town of Barnstable Building
� isi' ?.
PostThis;Card So That�t,Is VisibleFromthe Street Approu�edPlans Must�be.Retamed:on Job antl#hisCard Musibe Kept
M" Posted Until:final Ins ect on Has Been Made - �. .j
Where a Cert�ficate'of�Occupancy�s Required,such Bu�ldmg shell Not be Occupied until a Final Inspection has been made' Permit
Permit No. 13-20-233 Applicant Name: HOMEOWNER IS APPLICANT Approvals
Date Issued: 02/07/2020 Current Use: Structure
Permit Type: Building-Alteration INTERIOR Work Only- Expiration Date: 08/07/2020 Foundation:
Residential Map/Lot: 306-261 Zoning District: RB Sheathing:
Location: 11 PERIWINKLE DRIVE, HYANNIS Contractor`Name: HOMEOWNER IS APPLICANT Framing: 1
Owner on Record: CROSSLEY,SUELLEN F Contractor License: EXEMPT
a 2
Address: 11 PERIWINKLE DRIVE Est Project Cost: $52,222.00 Chimney:
HYANNIS, MA 02601 Permit Fee:
$316.33
Description: Kitchen dining area renovation fire Insulation:
p g Fee Paid F $316.33
Bathroom renovation fire ; Final:
Bathroom renovation fire 2nd floor. : -> Date 2/7/2020
Plumbing/Gas
Project Review Req: k � < s "
Lr �rn
�7 7777777 Rough Plumbing:
>; Building Official
i Final Plumbing:
This permit shall be deemed abandoned and invalid unless the work authonzed by this permit is commenced within six rnonths4fter-issuance.
All work authorized by this permit shall conform to the approved appl atio and the approved construction documents fog whff ch�this permit has been granted. Rough Gas:
All construction,alterations and changes of use of any building and structures"shall Ibe in compliance with the local zoning by lawsµand codes.
This permit shall be displayed in a location clearly visible from access street or roadYand shall be maintained open for public mspecti in for the entire duration of the Final Gas:
work until the completion of the same..
71
Electrical
The Certificate of Occupancy will not be issued until all applicable signatures bythe Building a,Q Fire Officials are provided on this permit.
Minimum of Five Call Inspections Required for All Construction Work Service:
a >.
1.Foundation or Footing � �� � � � � ' � ,21''
'r
2.Sheathing Inspection l�f ��r. � � '�� �" `' Rough.
3.All Fireplaces must be inspected at the throat level before firest flue lining is installed
4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Final:
5.Prior to Covering Structural Members(Frame Inspection)
6.Insulation Low Voltage Rough:
7.Final Inspection before Occupancy
Low Voltage Final:
Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health
Work shall not proceed until the Inspector has approved the various stages of construction.
Final:
"Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A).
Building plans are to be available on site Fire Department
All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Final:
C.....Application Number. ......2.0.......4�.3. .........
BAWWABLF,
MASS. g Permit Fee...................... .............Other Fee:.
16.59.
Total Fee?J5L............ v. ................................ ......
TOWN OF BARNSTABLE Permit Approval by... .................on...a—..7
BUILDING PERMIT 0?
map.. ."3Q.44P..................Parcel...... ..................
APPLICATION
Section 1 — Owner's Information and Project Location
Project Address '11 fbr�� Q&,k, Village %kxnn�s
. SCA ED
Owners Name
FEB 0 6 2020
Owners Legal Address ki pey�WPC kp,
City,WA. State NVA zip
% cro<5 lel 5,wej I
Owners Cell#. 501Z 0- -1:3-6— CM0 E-mail Sv�21 P � �'*� �r S
FSection 2 —Use of Structure
Use Group_ ❑ Commercial Structure over 35,000 cubic feet
❑ Commercial Structure under 35,000 cubic feet
Single/Two Family Dwelling
Section 3 — Type of Permit
❑ New Construction F] Move/Relocate [:] Accessory Structure ❑ Change of use
El Demo/(entire structure) ❑ Finish Basement El Family/Amnesty El Fire Alarm
Rebuild El Deck Apartment Sprinkler System
❑ Addition ❑ Retaining wall ❑ Solar
14 Renovation ❑ Pool El Insulation
Other—Specify.
DUILBING 9 T.
Section 4 - Work Description
JAN 2 4 2020
LA-cy�� ovpa rr
TO �AIN nF BARNSTABLE
los�f6my-% MYNAAon — f(COr
Application Number....................................................
Section 5—Detail
fi
Cost of Proposed Construction SI, =. -L Square Footage of Project
Age of Structure Dig Safe Number
# Of Bedrooms Existing 3 Total#Of Bedrooms (proposed) 3
110 MPH Wind Zone Compliance Method ❑ MA Checklist ❑ WFCM Checklist ❑ Design
Section 6—Project Specifics
=Wiring ❑ Oil Tank Storage Smoke Detectors
tE11'Plumbing ❑ Gas ❑ Fire Suppression
❑ Heating System ❑ Masonry Chimney ❑ Add/relocate bedroom
Water Supply Public ❑ Private
Sewage Disposal 9 Municipal ❑ On Site
Historic District ❑ Hyannis Historic District ❑ Old Kings Highway
Debris Disposal Facility: r ou rn p� '6"n4aL of 1 �4zir I am using a crane ❑ Yes No
'or1
Section 7—Flood Zone
Flood Zone Designation AS
Within or adjacent to a wetland, coastal bank? Yes No ❑
Section 8—Zoning Information
Zoning District u Proposed Use n ,�� Lot Area Sq. Ft. 1.
Total Frontage 250,0 Sr Percentage of Lot Coverage C 14`7D #of Dwelling Units (on site)�( _
Setbacks Front Yard Required Proposed
Rear Yard Required Proposed
Side Yard Required Proposed
Has this property had relief from the Zoning Board in the past? ❑ Yes 0 No
Last updated: 11/15/2018
The Commonwealth of Massachusefis
Department of IndustrialAccidents
Office of Investigations
600 Washington Street
Boston,MA 02111
www massgov/dia
Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers
Applicant Information 1 Please Print Legibly
Name(Business/Organization/Individual): NQ(I�Pn �. CYPriS 13P- I
Address: 1 Y��l�y��lP. Dti\ko
City/State/Zip: 02L Phone#:
Are you an employer?Check the appropriate box: Type of project(required):
1.❑ I am a employer with 4. ❑ I am a general contractor and I
employees(full and/or part-time).* have hired the sub-contractors 6. []New construction t
2.❑ 1 am a sole proprietor or partner- listed on the attached sheet: 7. EqRemodeling
ship and have no employees These sub-contractors have g• ❑Demolition
working for me in any capacity.acitY• employees and have workers'
t 9. El Building addition
[No workers'comp.insurance comp•insurance.
required..] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions
3. I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions
myself[No workers'comp. right of exemption per MGL 12.❑Roof repairs
insurance required.]t c. 152,§1(4),and we have no
employees.[No workers' M❑Other
comp.insurance required.]
*Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have
employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. ,
I am an employer that is providing workers'compensation insurance for my employees. Below is thepolicy and job site
inf ormadom
Insurance Company Name:
Policy#or Self-ins.Lic.#: Expiration Date:
Job Site Address: City/State/Zip:
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do h erebik certify under the pains(and penalties of perjury that the information provided above is true and correct.
Signature:
Date: 0 �`t' 20�
Phone#• ,
Official use only. Do not write in this area,to be completed by city or town official
City or Town: Permit/License#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.City/Town Clerk 4.EIectrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
Information and Instructions
Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees.
Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire,
express or implied,oral or written."
An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more
of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the
receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the
owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the
dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house
or on the groumds or building appurtenant thereto shall not because of such employment be deemed to be an employer."
MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or
renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any
applicant who has not produced acceptable evidence of compliance with the insurance coverage required."
Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall
enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance
requirements of this chapter have been presented to the contracting authority."
Applicants
..
Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if
necessary,supply sub-contractor(s)name(s),address(es)and.phone number(s)along with their certificate(s)of
insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the
members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have
employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial
Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should
be returned to the city or town that the application for the 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. Self-insured companies should enter their
self-insurance license number on the appropriate line.
City or Town Officials
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom
of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant.
Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant
that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current
policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or
town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the
applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each
year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture
(i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit.
The Office of Investigations would hike to thank you in advance for your cooperation and should you have any questions,
please do not hesitate to give us a call.
The Department's address,telephone and fax number:
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston,MA 02111 -
Tel.#617-727-4900 ext 446 or 1-877-MASSAFE
Revised 4-24-07 Fax##617-727-7749
WWW:maw.gov/dia
Flaherty Associates
SKETCH ADDENDUM File No. Crossley
Case No.27345.012
Borrower
Property Address 11 Periwinkle Drive
Cf H annis County Barnstable State MA Zip Code 02601-4465
LenderlClient Attomey Steven S L)eYoung Address 270 Winter Street Hyannis,MA
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2019-09-19-1533 9/27/2019 Page: 13
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Application Number...........................................
Section 9- Construction Supervisor ,
Name Telephone Number
Address City State Zip
License Number License Type Expiration Date
Contractors Email Cell #
I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780
CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and
documentation required by 780 CMR and the Town of Barnstable.Attach a copy of your license.
Signature Date
Section 10—Home Improvement Contractor
Name Telephone Number
Address City State Zip
Registration Number Expiration Date
I understand my responsibilities under the rules and regulations for Home Improvement Contractors in accordance with 780
CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and
documentation required by 780 CMR and the Town of Barnstable.Attach a copy of your H.I.C...
Signature Date
Section 11 —Home Owners License Exemption
Home Owners Name:
Telephone Number-c,56S - Flo —p32L7 Cell or Work Number
I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780
CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and`
documentation required by 780 CMR and the Town of Barnstable.
Signature Date Zy ` -Z-OZ-0
APPLICANT SIGNATURE
Signature \ ` Date k' _ tab
Print Name '5��en T" . c ICA Telephone Number SM - i-�-lo— 03
E-mail permit to: 6r05,�>lf',j —s1AE i1-e.12,(Zm\rby5, oS
Last updated: 11/15/2018
Section 12—Department Sign-Offs
Health Department ❑ Zoning Board(if required)
Historic District ❑ Site Plan Review(if required) ❑
Fire Department ❑.
Conservation ❑ -
For commercial work,please take your plans directly to the fire department for approval
Section 13—Owner's Authorization
as Owner of the subject property hereby
authorize to act on my behalf, in all
matters relative to work authorized by this building permit application for:
(Address of j ob)
Signature of Owner date
Print Name ,
f
Last updated: 11/15/2018
_ Town of Barnstable Building
IPost,This Card So That it is Visible From the Street Approved Plans Must be Retained on"Job and this Card. be Kept
.AnciSreece 1
MAs !Posted Until Final-Inspection Has Been Made Permit
tbsa ��
Where a Certificate of Occupancy;is Requiredi_.such Building shall Not be Occupied until a Final Inspection has been made
.r.-...-,.at-
Permit NO. B-19-3079 Applicant Name: MULTISTATE RESTORATION CAPE COD DIVISION INC. Approvals
Date Issued: 09/26/2019 Current Use: Structure
Permit Type: Building-Alteration INTERIOR Work Only- Expiration Date: 03/26/2020 Foundation:
Residential Map/Lot: 306-261 Zoning District: RB Sheathing:
Location: 11 PERIWINKLE DRIVE,HYANNIS Contractor Name: MULTISTATE RESTORATION CAPE Framing: 1
Owner on Record: CROSSLEY,SUELLEN F COD DIVISION INC.
2
Address: 11 PERIWINKLE DRIVE Contractor License: 140427
Chimney:
HYANNIS, MA 02601 Est. Project Cost: $4,800.00
Description: removal of some sheetrock&flooring due to water damage. Permit Fee: $85.00 Insulation:
Remove sheetrock in 1st floor, bath,upper bath and remove Fee Paid: $85.00 Final
flooring in kitchen-no structurre removal and no rebuild-demo
only. Date, 9/26/2019
Future permit for installation Plumbing/Gas
Rough Plumbing:
Project Review Req:
Building Official Final Plumbing:
This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months after issuance. Rough Gas:
All work authorized by this permit shall conform to the approved application and the approved construction documents for which this permit has been granted.
All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by-laws and codes. Final Gas:
This permit shall be displayed in a location clearly visible from access street or'road and shall be maintained open forpublic inspection for the entire duration of the
work until the completion of the same. #• w--- .- r Electrical
The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this permit. Service:
Minimum of Five Call Inspections Required for All Construction Work:i Rough:
1.Foundation or Footing g
2.Sheathing Inspection
3.All Fireplaces must be inspected at the throat level before firestflue lining is installed Final:
4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Low Voltage Rough:
5.Prior to Covering Structural Members(Frame Inspection)
6.Insulation Low Voltage Final:
7.Final Inspection before Occupancy
Health
Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations.
Work shall not proceed until the Inspector has approved the various stages of construction. Final:
"Per s 3-een cting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Fire Department
Building plans are to be available on site Final:
All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT
Application Number.... ..................
• BARNSTAKY, •
MASS. Permit Fee.........FS......................Other Fee,........................
1639.
Total Fee Paid............. ................................
................. ..
Gw 9
TOWN OF BARNSTABLE Permit Approval by...... ........... ..........
BUILDING PERMIT MV.........3.6.60...............Parcel......!:;:R.A�1.....................
APPLICATION
Section 1 — Owner's Information and Project Location
Project Address j Pso ZZ ( to i d 1< Le- �K —Village- #Mijiva,"
Owners Name_ SVetleW
Owners Legal Address A'1V e.
City. . State M--q zip
Owners Cell# S-D 9 7 76 - 0 3 VV E-mail
ISection 2 -Use of Structure
Use Group_ qtc-P Fj Commercial Structure over 35,000 cubic feet
Commercial Structure under 35,000 cubic feet
Single/Two Family Dwelling
Section 3 -Type of Permit
❑ New Construction ❑ Move/Relocate EJ Accessory Structure ❑ Change of use
❑ Demo/(entire structure) 0 Finish Basement ❑ Family/Amnesty 0 Fire Alarm
Rebuild ❑ Deck Apartment El Sprinkler System
EJ Addition ❑ Retaining wall Solar
❑ Renovation ❑ Pool El Insulation
Other-Specify P-0170V& v -- t�rl>�Om e
Section 4 - Work Description
oe-4-
v-e r-1 a6 -'eQ /A-j A .,rcAelv A#-'f)a ,ft
0 /V,
T---A-A. I 1 11 9PIA1 0
Application Number.......... ......................................... ;
Section 5—Detail
Cost of Proposed Construction A'7 84>0 --- Square Footage of Project
Age,of Structure Dig Safe Number
# Of Bedrooms Existing Total#Of Bedrooms (proposed)
110 MPH Wind Zone Compliance Method 0 MA Checklist ❑ WFCM Checklist ❑ Design
Section 6—Project Specifics
❑ Wiring ❑ Oil Tank Storage ❑ Smoke Detectors
❑ Plumbing ❑ Gas ❑ Fire Suppression
❑ Heating System ❑ Masonry Chimney ❑Add/relocate bedroom
Water Supply ❑ Public ❑ Private
Sewage Disposal ❑ Municipal ❑ On Site
Historic District ❑ Hyannis Historic District ❑ Old Kings Highway
i
Debris Disposal Facility: I am using a crane ❑ Yes ❑ No '
I ;I
Section 7—Flood Zone
Flood Zone Designation
Within or adjacent to a wetland, coastal bank? Yes ❑ No ❑
Section 8—Zoning Information
Zoning District Proposed Use Lot Area Sq. Ft.
Total Frontage Percentage of Lot Coverage # of Dwelling Units (on site)
Setbacks Front Yard Required Proposed
Rear Yard Required Proposed
Side Yard Required Proposed
Has this property had relief from the Zoning Board in the past? ❑ Yes ❑ No
Last undated: 11/15/2018
no�ac/u�arlta 1
' office of Consumer Affairs&eusf Rness e9u"*"
Registration valid for individual use only HOME IMPROVEMENT CONTRACTOR
before the expiration date. If found return to: TYPE. Card
Office of Consumer Affairs and Business Regulation _
10 Park Plaza-Suite 5170 _ 1011412019
1 --
Boston,MA 02116 E COD DIVISION,INC.
MULTISTATE R
RIC HARD LAURIA
Not vall ithOut signature 21 PEOUOT RD.
MASPHEE,MA 02649 Undersecretary
Construction Supervisor 1&2 Family
Failure to possess a current edition of the Massachus,
State Building Code is cause for about revocthis ation
not this lice
For informs rnass.govldpl
Call(617)727-3200 or visit www.
a�f Commonwealth of Massachusetts
Division of Professional Licensure
Board of Building Regulations and Standards
Constructio'N511 -0i 0t,1 & 2 Family
CSFA-051784 M b +4pires: 04/01/2021
y.Ay
RICHARD D LAURIA
1 LEAN DR
ROCKLAND MA J2370 �•� i
Commissioner
AC"RO CERTIFICATE OF LIABILITY INSURANCE DATE(MM!DDiYyYY)
F 9/17/2019
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(ics)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 Maureen Roderick
............ ............
..... ..........................
Horgan Insurance Agency PHONE (508T755-5830 F;� ..
x
INC,No.Ext)* It'r 2!_-
44 Barnstable Rd. E-MAIL
maureenr@horganinsurance.com
P.O. Box 250 S' AFFORDING COVERAGE NA!C 4
Hyannis MA 02601
Insurance Co.
INSURED
INSURER 8:
....................
Multi State ResioratJon, -ape Cad Division, Inc, INSURER C!
POBox 2210 ................ ................................-.......................................
!NSURER 0
. .................. ........................................ ........................................................................................................... .....................................-......................
INSURER E
............
Masi:pee MA 02649
I INSURER F
COVERAGES CERTIFICATE NUMBER:Clll 977 2401334 REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES 0:FINSURANCE._ISTED BELOW HAVE BEEN ISSUED TO THE INSURF-D NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH'THIS
CERTIFICATE MAY BE ISSUED OR PVIAY PERTAIN,THE INSURANCE AFFORDED BY I HE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL-THE I ERPJS.
. AT
,EXCLUSIONS AND CONDITIONS OF SUCH POLICI ES.LIMITS SHQVvN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
rXbbE 9'(i9k.
LTR TYPE OF INSURANCE POLICY EFF POLICY EXP
WS0 wvo POLICYNUMBER MMIIDDNYYY) IMMIDWYYYY i LIMITS
7
COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE
...............-................. ....................-..............
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RSON'AL8 A IN iURY
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UMBRELLA UAB OCCUR EAC,11.i Cr,-_URREV',�
EXCESS LIAB MrMADE i
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D
ORKERS COMPENSATION OTH.
DER
AND EMPLOYERS'LIABILITY
YIN SWWE
-X--
E.Ri C A--I I AC(,'I D E N.1.
N iA 500,000
.......................
(Mandatory in NH) F
A
R2WC03'649
1116/2019 vl.E/2020
P%.0YEE is 500,000
Ei-DISEASE POU,.,YLIWT
...................
DESCRIP I ION OF OPERATIONS_LOCATIONS'VEHICLES-fACCRID 101-,Additional Ramarks Schedule,may 6a attached if morn space is niiquired}
7�11 Periwinkle Dr-, Hyaruils, MA 02601
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE,ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
Town of Barnstable THE EXPIRATION DATE THEREOF.NOTICE WILL BE DELIVERED IN
200 Main St. ACCORDANCE WITH THE POLICY PROVISIONS.
Hyannis, MA 02601
AUTHORIZED REPRESENTATIVE
Cd)1988-2014 ACORD CORPORATION, All rights reserved.
ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD
INS025
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MULTI—STATE RESTORATION, INC.
FIRE* FLOOD*WIND * SMOKE *HURRICANE*VANDALISM
Fed ID#050515889 CONTRACTORS REGISTRATION#140427
AUTHORIZATION TO PERFORM SERVICES AND
DIRECTION OF PAYMENT
herein referred to as "Customer",authorizes
MULTI-STATE RESTORATION,INC.,herein referred to as "MULTI-STATE",to
perform any and all necessary cleaning and construction services on Customers'property
at:A S G\rin1
Telephone: S(��
and with respect to items that need to be cleaned at a remote location,to remove and
clean such items as necessary. .\S`
St%rl
Customer authorizes '( U56 fG\*f V�Ckn _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 checks or
drafts for MULTI-STATE services. Customer agrees to pay-Customers' deductible in the
amount of$ '2500 • that applies to this claim.
If the loss is not covered by insurance,Custo agre to pa e tot 1 amo nt to
MULTI-STATE upon receipt of the invoice. kill
Signature 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.
NiX�6 NQ�eX 11ns 6�_k UX�`�sn� '
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: T"\oe- ( AU►'�.
I ve a document and completely understand and agree to same. 42
CA
Signature 1\ { ` Date
Printed Name
P.O. BOX 2210•MASHPEE, MA 02649 .866-921-9111 •FAX 774-238-4422
The Commonwealth of Massachusetts
Deparbnent of Industrial Accidents
Office of Invesfigadons
IF 600 Washington Street
Boston,MA 02111
www mass govldia
Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Lesibly
Name(Business/0rgeninitim4ndividual): M ItQTI S'%/a'TP fft BIZ a-,f l��✓✓
---------..
Address: )v1 tC L.-e.i-rA r.S` l y
City/State/Zip: /L IA5 h pe(. Phone#: 4 77 — 3 5 33
Are you an employer?Check the appropriate box: Type of project(required):
1.�.I am a employer with � 4. I am a general contractor and I 6: New construction
O
employees(full and/oor pCdart�time).* have bhvd file sub-contractors
2.[3 I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling
ship and have no employees These sub-contractors have S. 9-Demolition .
working for mein any capacity. employees and have workers'
gyp,insutaace3 9. ❑Building addition
[No workers'comp.insurance
l 5. We are a corporation and its 10.❑Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their I L❑Plumbing repairs or additions
of exemption MGL .
m saki: o workers � per�ce )t � c.152,§1(4),and we have no 12. Roof aus
employees.[No workers' 13.❑Other
comp.instance required.]
*Any applicant that checks box 61 most also fill out the section below showing their workers'coon policy infinImation.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
=Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have
employees. If the sub-contractors have employees,they must provide their workers'comp.policy number.
lam an employer that is providing workers'compensation insurance for my employees Below is the policy and job site
Information.
Insurance Company Name: AtI G u.^114c-
Policy#or Self-ins.Lic.#: L%C O 3 16 q Expiration Date: _i.(, ` D-c7
Job Site Address: I t Pc.'/t t t;v i u fC LC -/7:>/L City/State/Zip:
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the foam of a STOP WORK ORDER and a fine
of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby cerl jy u r thqains and penalties of perjury that the information provided above is true and correct
Simatare: Date:
Phone#: —7 l Y ' S 6 7
Oftial use only. Do not write in this area,to be completed by city or town opWal
City or Town: Permit/License#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.City/Town- Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
Information and Instructions
Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees.
Pursuant to this statute,an enrloyee is defined as"...every person in the service of another under any contract of hire,
express or implied,oral or written."
An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more
of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the
receiver or trustee of an individual,pariaecship,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 oft 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."
MOL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or
renewal of a license or permit to operate a business or to construct buildings In the commonwealth for any
applicant who has not produced acceptable evidence of compliance with the insurance coverage regnn^ed."
Additionally,MOL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall
enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance
requirements of this chapter have been presented to the contracting authority"
Applicants
Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if
necessary,supply sub-contractors)name(s),address(es)and phone numbers)along with their certificate(s)of
insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the
members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have
employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial
Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should
be returned to the city or town that the application for the 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. Self-insured companies should enter their
self-insurance license number on the appropriate line.
City or Town Officials
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom
of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant.
Please be sure to fill in the penmittlicense number which will be used as a reference number. In addition,an applicant
that must submit multiple permittlicense applications in any given year,need only submit one affidavit indicating current
policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or
town)"A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the
applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each
year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture
(i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit.
The Office of Investigations would hlce to thank you in advance for your cooperation and should you have any questions,
please do not hesitate to give us a call.
The Department's address,telephone and fax munber
The Commonwealth of Massachusetts
Department of Industrist Accidents
Qffiee of Investigationrs
6W Washington Street
Boston,MA 02111
Tel.#617-727-4900 ext 406 or 14M-MASSAFB
Fax#617-727-7749
Revised 4-24-07 . Www.mass.gov/dia
II
Application Number...........................................
Section 9- Construction Supervisor
Name R l C l-�A/Lcl 1-A ut iAA Telephone Number 7 k( -2Z y- 5(-- '7 7
Address ( LCA( P 2. City 1Z6)c State A-tA Zip 4�v 3 -7z)
License Number f'SSA y License Type/+Z Expiration Date
Contractors Email L, u,2 A Z/ 7 12 J13/4J, G-birl Cell # e7�l a G -3-6 77
I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780
CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and
documentation required by 7 , CMR and the Town of Barnstable.Attach a copy of your license.
Signature Date � " f-7-1Y
Section 10—Home Improvement Contractor
Name_ (L[ c w/�"! L.-!� u 2 r/� Telephone Number �7 y -S-Z 7 7
Address i L ►7A-- City !2 pG4'Let'c( State/4,4 Zip 0�)3 -70
Registration Number/a o �c,2 7 Expiration Date 1 b"'r 5 ( ?
I understand my responsibilities under the rules and regulations for Home Improvement Contractors in accordance with 780
CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and
documentation required by 780 CMR d the Town of Barnstable.Attach a copy of your H.I.C...
Signature Date y 1j i9
Section 11 —Home Owners License Exemption
Home Owners Name:
Telephone Number Cell or Work Number
I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780
CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and
documentation required by 780 CMR and the Town of Barnstable.
Signature Date
APPLICANT SIGNATURE
Signature Date
Print Name �i ✓YcJ L 14-u At n Telephone Number -7 5- 7 7-
E-mail permit to:
Last updated: 11/15/2018
Section 12 —Department Sign-Offs
Health Department ❑ Zoning Board(if required) ❑
Historic District ❑ Site Plan Review(if required) ❑
Fire Department ❑
Conservation ❑ 4
For commercial work,please take your plans directly to the fire department for approval
Section 13— Owner's Authorization o ation
i
as Owner of the subject property hereby
authorize to act on my behalf, in all
matters relative to work authorized by this building permit application for:
(Address of job)
Signature of Owner date ,
Print Name
Last updated: 11/15/2018
YOU WISH OPEN A BUSINESS?
For Your Information: Business certificates [cast$40.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you
must do by M.G.L.-it does not give you permission to operate.) You must first obtain the necessary signatures on this form at 200 Main St., Hyannis.
Take the completed form to the Town Clerk's Office, 1st FI.,367 Main St., Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is
required by law.
DATE: z2—' zo11 FiQ in please: ,
APPLICANT'S YOUR NAME/S; h X) H- U0551.04
BUSINESS YOUR }SOME AD RES$:
•r . 3�4- Z(o�' 1${�� 11 k�Px�w� l� 1 �v� c, nos i_AAA , 0?(,-_I_?_1 --- i
TELEPHONE # Home Telephone Number o!-:?"SO
NAME OF CORPORATION:
NAME OF NEW BUSINESS Snter TYPE OF BUSINESS irvic S !
\1 IS THIS A HOME OCCUPATION? YES NO '1MtW1YV�Cb�
. ADDRESS OF BUSINESS MAP/PARCEL NUMBER 136 6�1 CD (0 f (Assessing)
When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of
Barnstable. This fonn:is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. — (corner of Yarmouth
Rd. &Main Street) to'make sure you have the appropriate permits and licenses required to legally operate your business in this town.
1. BUILDING CO 1SS10 ER'S OFFICE
This individual h n i� f any p unit requirements that pertain to this type of businMUST COMPLY WITH HOME OCCUPATION
' Aut , riz Si nacre** RULES AND REGULATIONS. FAILURE TO
4 COMPLY MAY RESULT IN FINES.
COMMES�.E ��
2. BOARD OF HEALTH
This individual In n info he p mit re irements that pertain to this type of business.
Authorized nature** MUST WITH ALL
COMMENTS: 111I12APDOXR$NIA F"IH.ATM
3. CONSUMER AFFA;a_b
S (Ll 51NG AUTHO
This individual f f the I' i g eq a ents that pertain to this type of business.
Authorized Sig
COMMENTS:
I
Town of Barnstable
4 TME Regulatory Services
�F Tn.
do Richard V. Scali,Director.OWN 0r-
sTAB Building Division
&MMv� , . `�8 Tom Perry,Building Commissio JUL
22 't 1 C O1.1 +
QED 39 A 200 Main Street,Hyannis,MA 026001
www.town.barnstable.ma.us
Office: 508-862-4038 DIVISION Fax: 508-790-6230
Approved:
Fee:
Permit#: '�C
HOME OCCUPATION REGISTRATI N
Date:
Name: � 1y w 6L Phone#: SL
Address: t1 �PJt\W�`n t. \� Ur Village: NaylmS 0l,,� 6
Name of Business:_ (rL�JS YET JY�YI� __—'", 7 -- _0A �1 v i I M M��
Type of Business: mZ _ Y �Vl /Lot: 3o(o b
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 residential volumes,-
and no increase in air or groundwater pollution.
After registration with the Building Inspector,a customary home occupation shall be permitted as of right subject to the
following conditions:
• The activity is carried on by the permanent resident of a single family residential dwelling unit,located within
that dwelling unit.
• Such use occupies nomore than 400 square feet of space.
• There are no external alterations to the dwelling which are not customary in residential buildings,and there is
no outside evidence of such use.
• No traffic will be generated in excess of normal residential volumes.
• The use does not involve the production of offensive noise,vibration,smoke,dust or other particular 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 of
normal household quantities.
• Any need for parking generated by such use shall be met on the same lot containing the Customary Home
Occupation,and not within the required front yard.
• There is no exterior storage or display of materials or equipment.
• There are no commercial vehicles related to the Customary Home Occupation,other than one van or one
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.
I,the undersi ed,ha e ead and agree with the above restrictions for my home occupation I am registering.
Applicant: v\ Date: 2 2 I20 I
Homeoc.doc Rev.103113
YOU WISH TO OPEN A BUSINESS?
For Your Information: Business certificates (cost$40.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you
must do by M.G.L.-it does not give you permission to operate.) You must first obtain the necessary signatures on this form at 200 Main St., Hyartnis,
Take the completed form to the Town Clerk's Office, l st FI., 367 Main St., Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is
required by law.
DATE: 2•Z, Z�I Fi I in please: ,
nMM�Ff 'rxr APPLICANT'S YOUR NAME S Sue 11�m �5���1 Arun �ielp�"t�# 7��� S� `]at�1r�5 T�c�r i
/ CJ
BUSINESS YOUR I;J_0M(E AD4 RES
TELEPHONE # Home Telephone Number 0spo
NAME OF CORPORATION:
NAME OF NEW BUSINESS Sn TYPE OF BUSINESS
IS THIS A HOME OCCUPATION? YES NO ml mmco)
ADDRESS OF BUSINESS QZLO MAP/PARCEL NUMBER 36 6n c Co I (Assessing)
When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of
Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. - (corner of Yarmouth
Rd. &Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town.
1. BUILDING CO ISSIOLER'SOFFICEThis individ al h e . m�ed f a y p rmit requirements that pertain to this type of businRUST COMPLY WITH HOME OCCUPATION
Aut oriz Sin re** RULES AND REGULATIONS. FAILURE TO
COMMENT �� COMPLY MAY RESULT IN FINES.
D C �' 6.
2. BOARD OF HEALTH
This individual h n info m f the p twit re irements that pertain to this type of business.
Authorized nature** W JST COMPLY WITH ALL
COMMENTS: HAZARDOUS MATERIALS REGUtATI0IS ,
3. CONSUMER AFFA;be
ILI SING AUTHORI
This individual f of the I' si g eq ' e ents that pertain to this type of business.
Authorized Sig e*
COMMENTS:
Town of Barnstable
do Regulatory Services
��; - T (Thomas F:Geiler,Director
• swiuvsTwsLE •' L 0133 t j ( i U 14€f 1 : 4 J
9 MASS. Building Division
.s679 �m
'OTFo 39 Tom Perry,Building Commissioner
'�2b,0�1v1a Street;Hywnis,MA 02601
Office: 508-862-4038 �114P� AW*. Fax: 508-790-6230
PERMIT# 77178 FEE: $ ��i bO
SHED REGISTRATION
110 square feet or less
S
Location of shed(address) Village.
Property owner's name elephone number
ylr�x 1
30 2 �'
Size of Shed Map/Parc #
io fo
Signature Date
Hyannis Main Street Waterfront Historic District?
Old King's Highway Historic District Commission jurisdiction?
irC
required) D 2 ���� D
a- Conservation Commission(signature
PLEASE N.O:TE.:,IF.YOU ARE WITHIN THE JURISDICTION OF ANY OF THE ABOVE
"COMMISSIONS,THERE MAY BE A REVIEW PROCESS AND APPLICATION FEE.
PLEASE SEE THE"APPROPRIATE COMMISSION FOR DETAILS.
THIS FORM MUST BE ACCOMPANIED BY A PLOT PLAN
Q-forms-shedreg .
REV:121901
f
NOTE:nob,,•._ _
GO,
bn v ti Y EDGE OF DECID)j,
to EDGE OF BRUSH
' f--' ORCHARD OR NURSERY
v v v v EDGE OF CONIFEROUS TREES
MARSH AREA
CY ' - •— EDGE OF WATER
DIRT ROAD
DRIVEWAY
E�PARKING LOT
1 -
PAVED ROAD
/
ti \:.' ................ ----- DRAINAGE DITCH
---- PATH/TRAIL
PARCEL LINE
mAPito-<— MAP#
21 E PARCEL NUMBER
#1860 I HOUSE NUMBER
2 FOOT CONTOUR LINE
10 FOOT CONTOUR LINE
Elevation based on NGVD29
4.9 SPOT ELEVATION
A, STONE WALL
-X—X- FENCE
® m RETAINING WALL
9-#-i-i- RAIL ROAD TRACK
STONE JETTY
l D SWIMMING POOL
1�1 PORCH/DECK
Ma `lJ�+ BUILDING/STRUCTURE
F4=H- DOCK/PIER
HYDRANT
xr a VALVE ® MANHOLE
O POST p'P FIAG POLE
T O W N O F B A R N S T A B L E 6 E 0 0 R A P H .1 C 1 N. F O R M A T 1 O N S Y S T E M S U N 1 T a SIGN ® STORM DRAIN
N PRINTED SCALE:IN FEET *NOTE:This map is an enlargement of a **NOTE:The parcel lines are only graphic representation DATA SOURCES:Plonimetrics(man-made features)were interpreted from 1995 aerial photographs by The James p TOWER
1"=100'scole map and may NOT meet of property boundaries.They are not true locations,and W.Sewall Company.Topography and vegetation were interpreted from 1989 aerial photographs by GEOD 0 UTILIIY POLE
0 )0 20 National Map Accuracy Standards;at this do not represent actual relationships to physical obleds Corporation. Planimetrics,topography,and vegetation were mapped to meet National Map Accuracy Standards
s 1 INCH=20 FEET* enlarged stole. on the map. of a scale of 1"=IW.Parcel lines were digitized from FY2003 Town of Barnstable Assessors tax maps. 4 LIGHT POLE ® ELECTRIC BOX
F:\dgn\conservation.dgn 05/28/03 09:21:21 AM
Assessor's map and lot number ....f�1 r.<... f.�'I f .
' U i TN E
Sewage Permit number ��'�r ��r��,�*s. / •..;. 6� 0
Z EAR33TADLE. i
House number .. . ....! a. ...................................................... 90o NAG&
9�
't 0 MAY a`
TOWN OF BARNSTABLE
BUILDING INSPECTOR
�
APPLICATION FOR PERMIT TO .......... .. r,� SL' a+r... . F.......................
.........................
{ ,r
TYPE OF CONSTRUCTION ............................ ........... ...............................................
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according to the following information:
Location ......................L:..V....... '.. ..............................................................I �s'+ t s .................................
, r ...! ...�. ... ................ .r
....................... .... ...........Proposed Use .............................
Zoning District .....Fire District ''" �''
Name of Owner ...... . s'••L.r:.................. .... ......Address ............ R—oIf.... .. ..... ...................' i
y .... ......
Name of Builder' f%```' ...............................Address ............................. '. rya ? ..- ................................
....................................
Nameof Architect ..................................................................Address ....................................................................................
f
+� Foundation
Number of Rooms ....................�................................... .............�................................
'Exierior .............. ` Roofing ..... r i�'r!J6 ./ J
am-:� ......................r`......`:..... . 'v. ..... ..........., ....... ............................ ............
Floors C 4-6;� JV t� ...Interior .� �1 T'•... . �1 r�� ��...........................:.................... ...C........,...................... ...................
r � .. ...a •ye.+�v:✓ tL....
Heating .G.-� ;`.... .....� �:�`~.:f.................Plumbing ..... ' .` ........ ... .U t✓,%: ......... .........�
r
Fireplace ..................................................................................Approximate Cost ``b S
Definitive Plan Approved by Planning Board --------- � 19_ '� Area 's` ......................
................
Diagram of Lot and Building with Dimensions , � :
9 g i� C. �'�ZJ l.,�C. S Fee .................. ..
SUBJECT TO APPROVAL OF BOARD OF HEALTH ' �j
J
OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS
I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding tWabove
construction. J� k
6f �
41
Name ........................................................`.........................
GREENBRIER CORP. A=306-26/
No .2.3.8.8.4... Permit for ....One Story
...........................
Single Family Dwelling
...............................................................................
Location ...Lot....#.9A......1.1....P�r'.iwinlvle....Dr.
....... . ..... .... . ..... .........
Hyannis
...............................................Greenbrier ................................
--
Owner ........................L.e.r,/C/orp...../.............. ............
Type of Construction ........................ .................
Jame
...................... ... ......... .... ....................................
Plot ..................... ...... Lot ........... ...................
.... h 181 ..........19 82
Permit Granted ... .. .................
Date of Inspection .... ......I.......... ...........19
Date Completed ......I............ ..................19
A(
„�•"”'• TOWN OF BARNSTABLE Permit No. --------_
1 31AU9TAU Building Inspector Cash
2639.
OCCUPANCY PERMIT Bond
No building nor structure shall be erected, and no land, building or structure shall be
used for a new, different, changed, or enlarged use without a Building Permit therefor
first having been obtained from the Building Inspector. No building shall be occupied until a
certificate of occupancy has been issued by the Building Inspector."
Issued to Greenbrier Co:p, Address
1 ni- AQA 11 Ppri wi nlrl.-o T}ri vp_ Nvanni
' I
Wiring Inspector �^ Inspection date
Plumbing Inspectorwr f� Inspection date
v
Gas Inspector ,; ' _ ���
r.� n��M ,�::�<- ._.r�.,� ..�r� . Inspection date
p, Engineering Department . , Inspection date
THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL
SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN
REQUIREMENTS.
rat /jl..... 19
... _, .. .,Building Inspector....... ._. _. . . ._
Fses or's map and lot number ... A,0011,...
HE 7
�QyoF Toy o
Sewage Permit number/�� !t C .50�.� SEPTIC SYSTEM MUST
/ INSTALLED IN CC�MP��AlI t BaHa9TABLL
..l.House number, �..FYI WITH TITLE 5 90 rasa
(, Z w s• # 039AL .a\00
ENVIRONMEM
TOWN OF BARNS °`fiLE
BUILDING INSPECTOR
APPLICATION FOR PERMIT TO ........... .�.1. .............. .............
........... .. ..� .........................
TYPE OF'CONSTRUCTION ............................1/(1. �.�G..l...........F�..1.`mil . ..............................................
'eY..J... . ......19 �
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit accordin to the following. information:
Location ...................... :��...... .... :... .. .........................!.....3....... / �t—. ............................
ProposedUse ...... ............. .. .................................................................................
Zoning District .......................1 ..6...................................Fire District ,�
Name of Owner........t� `+ r'4.........................w!l r (,� ......Address .R.ctx...EY..4?. },� yn .* �--�...1�
_ 1
........... ....�.
Name of Builder' "� Address..................... . ",.................. ............................ :5. - t... ...........................
Nameof Architect ..................................................................Address ....................................................................................
•a
i
Number of Rooms ............ g�l....................................................Foundation .............. ..... .G�(.t................C.IJ�+-. T ....
Extelior -�'1 -� -t C (.� Roofings ......................................
.............--..//... ...... ,,, ................. i f ...
Floors .............. ......�.. ...���...........Interior ................� .v`.Q.�!..l...l... ....... ..
%-e
Heating ................ .l ...X....... ................Plumbin ....... ...... � CO ... .
l.�/ Plumbing :.................. .�/f�t... .. ... .......
-
Fireplace ..................................................................................Approximate Cost ........... .r..4 .1�................................:.
Definitive Plan Approved by Planning Board _______ _ ,�?119_ Area :.....:..................................
Diagram of Lot and Building with Dimensions F �0/a 5 Fee �2!X. 01
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 Barns a regarding th ve
construction.
w
Name ..................................................................................
'
- .
. . . _
GREENBRIER CORP.
` ~
—. ...—~ ory
Permit .` /One
—.—Si _—~. . —_
Location — � —.—I—l...� ive] ..
.
..
----.—./xYnu�A+.S.......................................... ' ~
' ^
Greenbrier Corp
Owner .--�------------�------.
Frame
Type of Construction ...........................................
...............................................................
Plot ............................ Lot ................................
.
! �
March I8' 83 '
Permit ----------��--.]g
' . `
. . . ^ . .
~~ .
Dote of |nopectiun,----------..—lA ` '
--_ Completed
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' .
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. . .
-
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. . . . .
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ef'EPt tJcZf=- 15 MAACE 10 Tc -140 of BA�-�BLE #.
N4, tL wj) POoTe:ncy,j kcr, FILE IJ° SE -3=-7eyo
DATED LECC-mBee 23, 196t
f.
F>L.AL4 'SH owr alb Pam`./ISE-D LvT L 11.11='S. L[>115
8A q A' APPRoQE:D B1( -!AP WSTA F3tE txA�.J1.I 11.J6
130PrP_D D3 IS•82 , A-+.�D To 6H QE-�D�D 1-FEREW.1'T�-I. ��.
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Io,aoo S.F: ����NOF ss CERTIFIED PLOT PLAN
wI Dm4 ; I CDO
F.S.B. ; 20
e,. ; io $ H Lcsr 9A- PR- wr'-Jr..L-c- DRIB
74�o IN
>�Ra
v�y° H-(Au N►s f3A 6L.� MASS .
4.:
SCALE: I = 5o DATE : o3. 16 . 02
ELDREDGE ENGINEERING CO.INCI CERTIFY THAT THE Fa+�DiR-r'tc�J
EGISTERED REGISTERED CLIENT �� SHOWN ON THIS PLAN IS LOCATED
CIVIL LAND JOG NO. 81os3 ON THE GROUND AS INDICATED AND
I ® s f� CONFORMS TO THE ZONING LAWS
ENGINEER SURVEYOR DR. Y OF M AIAS.
712 MAIN ST CH.By: PEE
os.i6
HYANNIS, MASS. SHEET I OF 1 DATE EG LAND SURVEYOR
/C-,A X .31IXeOL
Assessor's map and lot number .... i'�. ..
............ ...... ............./.!..:.... `� Q�pi THE t0�y
Sewage Permit number ��rr; �'"�' -�' ;`,•. .���- t `; w`` R ��
BAHBSTAME, i
f
House number .....10L.4t.'........................................:. ......... rasa
j n 90po�1639
- 'F0 ypY a`
TOWN OF 'BARNYSTABLE
BUILDING INSPECTOR
APPLICATION FOR PERMIT TO ......�
..................................................•..............................
TYPE OF CONSTRUCTION ................................ .... ............ �"
7.
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according to the following information:
Location .................. ..................... ... . rj d .................................... ...................
ProposedUse ............................... lr .!...:.......... .' :?..r `✓....................................................................................
Zoning District -.
.......................................................Fire District ................. .........................................................
Name of Owner >f . ; - '�..... . 'Address ...................l l+�.... '.........................................
h✓'i G�t�if
y .............
Name of, Builder' ��'.. '.............Address ..........................................� � -
1
Nameof Architect ..................................................................Address ..............................................:.....................................
,mot
;Number of Rooms ..............Foundation ' •"p 1 :,...,.,,..........
Exierior .........................................................::..... ..................Roofing .....................................................................................
Floors ...................`...... ........�..�` y . ............Interior .......... Jf!,- .......:.
I, Heating .'... ......7:....`- .!.. ................Plumbing .............. ` .............................. .` /. .
Fireplace p �.........................................Approximate Cost
Definitive Plan Approved by Planning Board _________--�_ f __-----------19------ . Area ' ..........................
Diagram of Lot and Building with Dimensions ( 1 J Fee -,<
SUBJECT TO APPROVAL OF BOARD OF HEALTH
t
OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS
I hereby agree to conform to all the Rules and Regulations of the Town of Barnstdble'regarding�the above
construction.
Name ....... ... :....... ``..... ...............
GREENBRIER CORP. -265
A=306
No .................2.3885 Permit for ............................. ......On e Story
Single Family Dwellin
..................................... ...................I...... ..............
Location Lot #11
........... ...I........ 9-a te...Dr.
..............H.Yan. . .s . ........ .. ...... ..................
Owner .....Gr b ier. Co
..... Co 9!?-r.rp.....................
Type of Construction .....EKAM ........................
.....................I........... . .................. ...................
Plot ..................................Lot .4..........................
Permit Gran led ...........Mar .............19 82
Date of Injection .......... .... ....................19
Date Completed ........ ....... .. ..................19
�� IPA.
US( SE
#Ss"zi-S-101,r s map and lot number ......... .. .c�l........�. :. Fy INSTALLED IN COP',APLIAIl C �oFTNE toy
Sewage Permit number/.�it�.+r,>n7'c0z --�.. WITH TITLE 5
ENVIRONMENTAL CODE At,
' 1;' BJBB9TOIILE, i -
House number .....1�L.11 .................................................... TOWN REGULATIONS ro rAea
p i639. e00
. a9 CHIN
TOWN OF BArRNSTABLE
BUILDING INSPECTOR
APPLICATION FOR 'PERMIT TO ..................................../.. .t................................................... .............v................
TYPE OF CONSTRUCTION ................................�1U � ...... / ? /;..........................................
............. a ..........19. �
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according to the following information:
L i 3 So -� D L t)-�- A*&".'s
Location ..........:.............. . ................................................l...:!.. .................�............... ..................
ProposedUse ............................... .�!� !/`�.......... ..................................................................................
Zoning District ...:......................... .... .-' .....:......................Fire District
p
Name'of Owner ........1`r V� f. .....C.��` Address ...................
Name ofv Builder' ............................ "'!�.............Address ......................................�..1. ..................................
Nameof Architect ..................................................................Address ................:...................................................................
Number. of Rooms ....:................. .......................................Foundation .......... .CQ
Exterior C.. �`'�• �.........:.......Roofing5
.............. .... ......................... .. ......................................................
Floors O/...lar ..fi.(/ l✓ L— ... ... .. � .............
....................Interior ................
1— -- _ _�,g� ��,
Heating .................r �"......................................Plumbing �v
.. ..... .. .. .. . .. ..
Fireplace ......................................................................:...........Approximate Cost ..... ... .... .. ............................
Definitive Plan Approved by Planning Board ------- 19 ! . Area ....R1 ..........................
Diagram of Lot and Building with Dimensions Fee ° D
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
r Tw rn regarding th ove
construction. Name ........ ... ..
GREENBRIER CORP.
23885 Permit for ....One Story.........
0 ................ .......................
;§.i.n.gle
...... ...FdM;Ll.y
Dwelli.ng..............
Location ..LQ.t...13.......1.Q1...Saurligat-a ..Dr.'
Hyannis
................................................................................
Owner ....G.re.enb.r.i.e.r...C.9rp......................
.. ..... ....... .. . .. ..
Type of Coristruction .....F,KAMP.........................
................................................................................
Plot ................. ............ Lot ................................
Permit 'Granted ... March 18.......................... .........19 32
Date of lnspectiorr*4/$..-Y-.Z..................19
Date Completed ........19
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30+
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W l CiTH ; Ic)o
OF
CERTIFIED PLOT PLAN
N Le=T ►3 '5 -I A-TE D(2I a/E
NEW CONSTRUCTION ONLY : " 28974 a
TOP OF FOUNDATION IS-2-5 FEE jf` IN
ABOVE LOW . POINT OF ADJACENT su AA al BS 1649 Ja jljW AS IS*
ROAD.
SCALE: = 50' DATE: 03 lam• 82
LDREDGE ENGINEERING CO.INO c-,�,8R,ck . I CERTIFY THAT THE FE:7u"tJA�7_lc>j
CLIENT 8(025 SHOWN ON THIS PLAN IS LOCATED
EGISTERED REGISTERED JOB NO. ON THE GROUND AS INDICATED AND
CIVIL I LAND CONFORMS TO THE ZONING LAWS
ENGINEER 1,SURVEYOR4 DR.BY, OF BARNSTAB E ,..u.A SS.
CH.BY,
71.2 MAIN STREET o3.lio 82 .-�- -
HYANRIS, MASS. SHEET OF I DATE (13SG. LAND SURVEYOR
TOWN OF BARNSTABLE Permit No. ----------___________
1 7iE13:I1L BUilfllIIg Inspector Cash ----_-----
� �NL
v0 f 630. `� I
WAY�' OCCUPANCY PERMIT Bond
No building nor structure shall be erected, and no land, building or structure shall be
used for a new, different, changed, or enlarged use without a Building Permit therefor
first having been obtained from the Building Inspector. No building shall be occupied until a
certificate of occupancy has been issued by the Building Inspector."
Issued to GreET brier Corp. Address
Wiring Inspector �� � � Inspection date
r Plumbing Easpecto ��( 4 Inspection date
Gas Inspector 4i4Z 14. -r-f Inspection date
X Engineering Department
Inspection date' /THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL
SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN
REQUIREMENTS.
! Z `'°
............................�....................,,19..._.� ...................J........;Building..Inspector,"..�.........._..._.