Loading...
HomeMy WebLinkAbout0061 TROTTERS LANE �, An a r�� M TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map 7 Parcel 3/ Permit# Health Division "—� Le-71 ' Date Issued 3) 06� Application Fee Conservation Division eo Tax Collector Permit Fee J0 Treasurer C —. Planning Dept. .1 Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis ems. Project Street Address Village /moo/�51 ►T Owner J �Y� ��/�S�/%f�9 Address �`�-'� r Telephone Permit Request r�( � s��r /,� ,cJ`/��,1��� E=9���► Square feet: 1 st floor: existing Zo 5-6 proposed 2nd floor: existing CST proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation I5Cce 6 Construction Type Lot Size f ��, Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family al Two Family ❑ Multi-Family(#units) Age of Existing Struct a Historic House: ❑Yes o On Old King's Highway: ❑Yes �No Basement Type: Full ❑Crawl ❑Walkout ❑Other i Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) F7G Number of Baths: Full: existing new Half:existing d new Number of Bedrooms: existing_ new la c'� Total Room Count(not including baths): existing 7 new First Floor Room Count Heat Type and Fuel: ❑ aG s 0 Oil ❑ Electric ❑Other YP �� . Central Air: 2 es ❑No Fireplaces: Existing New Existing wood/coal stove: 0 Yes ❑No Detached garage:reisting ing O new size Pool:Cl existing ❑new size Barn:O existing ❑new size Attached garage: ❑new size Shed:O existing ❑new size Other: 9 9 9 Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial O Yes Cl No If yes,site plan review# Current Use Proposed Use / BUILDER INFORMATION Name by c zLi e, Telephone Number Address (�, ��r -����/ License# 11—Zht-�fw1Tlz4 / S Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE FOR OFFICIAL USE ONLY PERMIT NO. • DA1'E ISSUED MAP/PARCEL',NO. • ADDRESS VILLAGE OWNER ; t I DATE OF INSPECTION: FOUNDATION FRAME N Z 6 S1G[oy INSULATION �olZjSoa FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. a The Commonwealth of Massachusetts Department of Industrid Aceidents' 6j0F Washington Street Boston,Mass. .02111 Workers' Com ensation.•Insurance Affidavit-General Businesses name: 2ddieSS state: ziphone# work � location full address : • am•a sole proprietor and have no one $usiness Types D Retail❑Restaurant%Baf/Eatiug.EstabIishment working in any capacity Office❑ Sales�includmg Real Estate,Autos etc.) ❑I am an em to with ' e>zilees�full& art time: ' ther ////%% �I am an em onployer provng:workers' compensation far my ployees working this job.. /: coIIipenV n>imet --- - eCldre9S: "�.>- ,.rp�;•tt; ;•j• .:r:i:' _ ..5::-:;' _ , '" :a:.•.;;'. t':�:'t.•r r ,. t'' ••� 'ti: lam'. a. '�A�tr}'te!�:%''.4..• �•' .. ;C:�: i .��: 't„i1."�`:i:� ... uri lce.co I am a sole proprietor and have hired the independent contractors listed belowwho have the following workers' .compensation polices: :.r:: � ;f' 7. ��,;� .:i':t•+ .:>:;.' .}; ,.:•.. - ,i> .•1•:', e;::�''.,���,:'� :.;^'J!� fit,•>,'.t:v�:':� r.�K:,!. COIL 9II •IIEIIte: -:i. _ - "r. '> .•.�+ i��_ >y�.. •:tt•N::�r.•,1. :,S•e:.:.':',:::i:�:fr''�t� �'1:' ' ... . '�t':��'' �'1+,'. :'.y:, t.,:y:�:`,�', '( r.i,..>-: . ,, lit :: � •c s. :.r,., ,�: addae's§d. � cif:• • t�- �'•- � .; . ' '. .. • 'T C `.� yS4^.off •'.. „D ii{.... !••'f ...:� '�,;>�;�,...•.'.. f..:::t'r•: ,1, �..iir•,•t,S •+v:%, �i•P. .•. .1•.}�•a:: t� � r•,, _ inSUr nee' 0. .4•. r:i +.. w .h e•, . �`: •O13C �y•.;:'•t' "q� '•s�.•'•!•r Y.. :.f�:�. •,L:i:'C.•n: ,{ •C�'••'Y•i.,;��..':.• �.. - '1 ..t>,•'i r ', . :,:�>:_•`. •Ct:. •'i i.Si•a.�..>�. •,t,. j �1..':'•.J..... ••_y'y'�•.s: ':Y.:•. •;SAS: fnsuranceioi !°':' T' �S;::G' .). OIiC•. : > ! :.:;•,.:, :> Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a1kne up to$1,500.00 and/or one years'imprisonment as well as civilpenalties In the foim of s STOP FORK ORDBR and a fine of$100.00 a day against me. I understand that I, copy of this statement may be forwarded to the Office of Inve' ow of the DIA for coverage verification. I do hereby certify er they d and penal ' perjury that the information provided above is true and correct Si tore ��! Dates Print name Phone# official use only . do not write in this area to be completed by city of town official L permit/license# ❑Building Department ❑Licensing Board mediate response is required ❑Selectmen's Office ❑HealthDepartment • phone#; ❑Other i i Information and Instructions. Massachusetts General L'aws;ch4apter�152 section 25.=equires all emgloyers.to provide workers'.compensation far their.. employees:' As quoted from the law', an employee is.defined as every person m 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 mgre 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'inore than three apartments and-who resides therein, or the.bccupant of the.dwelling house of another who.employspersbiis to do.maintenance, construction or repair work on such dwelling house or on the grounds or ereto shall not because of such employment.be deemed to be an employer. ,.. : building appiutenant th . :. MGL chapter 152 section 25 also'states thateve'r state'or total licensing•agency.shall withhold the issuance or renewal of a license or permit.to operate a business or to construct buildings in the.commonwealth for any applicant who has not produced acceptable evidence'of compliance with the insurance coverage required Additionally,neither the ' 61 commonwealth nor.any.of its political subdivisions shall enter into any contract for the performance of public work up acceptable evidence of compliance with t�e insurance requirements of this chapter have been presented to the contracting . authority- Applicants Please fiu in :the workers' compensation affidavit completely,by checking the box that applies to your situation.:Please supply company name, address and phone numbers along with a certificate of insurance as all affidavits may be submitted to the Departmeritof Industrial Accidents for confirmation of insurance coverage. A]so'be sure to sign and date the i affidavit. The affidavit should.be returned to the city or town that the application for the permit or.license is being of Industrial Accidents'. Should you have a�questions regardhi�the"law"or if you.are. requested, not the Department required to obtain a.workers.'•compensation policy,please call the-Departrrient at the number listed.bRIow. City or Towns . Please be sure that the affidavit is cbmplete 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 perrrrit/licens.e nuznb.er.which will be used as a reference number. The.affidavits may.be:returned to the Department by mail or FAX unless other'ariangements have been made. The Office of Investigations would like to thank yvu in advance for you cooperation and shouldyou have any questions, please do not hesitate to give us a.call.: The Department's:address,telephone and fax number. . The Commonwealth Of Massachusetts- Department.of Industrial Accidents 8mce of Wesugwens 600 Washington Street Boston,Ma. 02111 fax M (617)727-7749 phone#: (617) 7274900 ext-.406 �,8 t Town of Barnstable o � h Regulatory Services $ BnR1VSTABr.B, Thomas F.Geiler,Director 9�A 16 9. ,��� Buil.ding Division lfD N1P'� Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Fax: 508-790-6230 office: 508-862-4038 Permitno. Date AFFIDAVIT HOME 1WROVEM ENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,za c on vers red ion, improvement,removal,demolition,or construction of an addition to any pre-existing cuP building containing at least one but not more than four dwelling units or to structures which are adj acent to such residence or building be done by registered contractors,with certain exceptions,along with other regniren=ts- Type of Work: l�1y10 a"`� �1' G� meted Cost � Address of Work: S , 6wner's Name Date of Application: I hereby certify that: Registration is not required for the following reason(s): (]Work excluded by law ❑Job Under$1,000 []Building not owner-occupied ❑Owner pulling own permit Notice is hereby given that: UNREGISTEIMD OWNERS PUUVG THEIR OWN PERIYM OR DEROYEMENT WORK DO 0 HAVE CONTRACTORS FOR APPLICABLE HOME IlYIP ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER.MGL c.142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: Contractor Name Registration No. Date OR ' Date Owner's Name Q:forms:homeaffidav • RESIDENTIAL BUILDING PERMIT FEES APPLICATION New Buildings $100.00 Residential Addition $50.00 Alterations/Renovations $50.00 Building Permit Amendment $25.00 FEE VALUE WORKSHEET NEW LIVING SPACE square feet x$96/sq.foot= x.0041= plus frombelow(if applicable) AI,TLrRATIONSIRENOVATIONS OF EXISTING SPACE square feet x$64lsq.foot= plus frombelow(if applicable) GARAGES(attached&detached) square feet x$32/sq.ft.= x.0041= ACCESSORY$TRLICTURE>120.sq.ft. >120 sf-500 sf $35.00 >500 sf-750 sf 50.00 >750 sf-1000 sf 75.00 >1000 sf- 1500 sf 100.00 >1500 sf-.Same as new building permit' square feet x$96/sq.foot= x.0041= STAND ALONE PERMITS Open Porch _____x$30.00= (number) Deck x$30.00= (number) FireplacelChimney x$25.00= (number) Inground Swimming Pool $60,00 Above Ground Swimming Pool $25.00 Relocation/Moving $150.00 (plus above if applicable) permit Fee Projcost Rcv:063004 trle Town of Barnstable F rq� o� Regulatory Services Thomas F.Geiler,Director saaxsraBte. mass. 9 i639. Building Division �ArEo �a Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE- 3-c-9 ¢� JOB LOCATION: number street village . "HOMEOWNER!": RL_ ate 7 �!>g �[��3�� � 5`Ufl 70%�0 �a�1 name home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual*for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two-family dwelling, attached or detached structures accessory to such use and/or farm,structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under'the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with.the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and quirements and that he/she will comply with said procedures and requireme Signature of Homeo Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger.will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:forms:homeexempt ENERGY CONSERVATION APPLICATION FORM FOR LOW-RISE RESIDENTIAL NEW CONSTRUCTION and ADDITIONS 780 CMR Appendix J Applicant Name: Site Address: 7Z0 S_Lh)C. Applicant Address: City/Town: I cL5. Mk Use Group: Date of Application: Applicant Phone: Applicant Signature: Compliance Path(check one): ❑ Prescriptive Package(Limited to 1-or 2-family wood frame buildings heated with fossil fuels only) Package (A through KK from Table J5.2.1b): Heating Degree Days (HDD65)from Table J5.2.1a: (For items d. through i., fill in all values that apply from Table J5.2:1b:) a. Gross Wall Area sq.ft f. Wall R-value R- b. Glazing Area' sq.ft. g. Floor R-value R- .c. Glazing%(100 x b=a) % h. Basement wall R- d. Glazing U-value U- i. Slab Perimeter R- e. Ceiling R-value R- j. Heating AFUElv . Component Performance: "Manual Trade-Off'(Limited to wood or metal framed buildings only) Climate Zone(from Figure J6.2.2) Zone 12 ❑ Zone 13 ❑ Zone 14 Attach Trade-Off Worksheet from Appendix J, [and HVAC Trade-Off Worksheet, if applicable] ❑ MAScheck Software Attach Compliance Report and Inspection Checklist printouts ❑ Home Energy Rating System Evaluation Attach Home Energy Rating Certificate(HERS rating score must be 83 or higher) ❑ Systems Analysis OR ❑ Renewable Energy Sources Attach Mass Registered Architect or Engineer Analysis ALTERNATIVE FOR ADDITIONS ONLY: a. Gross Wall+Ceiling Area sq.ft. b.Glazing Area' sq.ft. c. Glazing%(100 x b=a) ❑ ADDITION with Glazing%(c.) up to 40% may use 780 CMR Table J1.1.2.3.1 below: MAXIMUM U-value MINIMUM R-Values Fenestration' Ceiling' Wall Floor 1 Basement Wall Slab Perimeter,Depth 0.39' R-37 R-13 R-19 I R-10 R-10,4 ft I Glazing Area may be either Rough Opening or Unit dimensions. 2 Based on NFRC listing. Applies either to every unit,or to area-weighted average of all units. 3 R-30 ceiling insulation may be used in place of R-37 if the insulation achieves the full R-value over the entire ceiling area (i.e.-not compressed over exterior walls,and including any access openings.) ❑ "SUNROOM" addition (greater than 40% glazing-to-wall and ceiling gross area) Attach"Consumer Information Form"from 780 CMR Appendix B. Official's Name: Official's Signature: Application Approved ❑ Denied ❑ Date of Approval/Denial: Reason(s) for Denial: (provide additional details as needed on back side) ` 780 CMR: STATE BOARD OF BUILDING REGULATIONS AND STANDARDS; THE MASSACHUSETTS STATE BUILDING CODE Manual Trade-Off Worksheet PermitNV Builder Name Date Chedced By Builder Address 1 f Site Address ZonePQ12 013 014 Date .• ^ h. Submitted By Phone PROPOSED REQUIRED �. Ceilings:SkvliAts.and Floors Over Outside Air Required Insulation x Net Area U-Value 13mri 'on R-Value U-Value UA (Table J6.2.2h) x Area UA N. ceiling ung --� 2 (Table 1612a Z 7 Z o Floor Over Outside Air It' (Table J613a) tY fv F. . . - ..Tow Area 6"3 tr' Walls.Windows:and Door ' Required pewripti*n R-Vaallve' U-V -Area. cs •UA U-Value x Area :UA ". (Table J6226:td) t�z Z I (c,?_fe 5ta' - 1Witidows (NFRCor Table Jl.S3a) ZtT 5c)— boas. (NFRCorTable J1.53b) sl--idiag Glus Doors — R° (NFRC orTabk 11.53a) ft= f Total Ara '1 12-ft Floors and Foundations Insuladoa Imulation R- x Area or Required Description Depth Value U-Valve' Perimeter -UA U-Value x A= 2.�L•A , Floor Over Uacoad'tti000d soace J61.24 T+b►4) ,�3 � ZZ'Z r0 5 ro 3 33'C Bssemew wan (table J6.2.2Q Uabcwod stab it (Table J6.Z2 ) in. Hated slab (Table J6.2.24 is retd Pr pared UA mac Nt tw To1a[ .-+ ToAQ[ 1 dumgrcqca t*rw((or.*xsa+Q Jtq.uta vA Pmporsed r&4 OR Requhvd UA Sontemcnt o(Comprwn=The pmpwW bml ft desipt repeesenood is L.._►Adjusted duff doearwea Jr conebtad with At 6wMWPfax&apee0500109L and odwr calculations submitted with the ioo. RtquGrd CA C07W'I'-r EAjbeZ eafldalDierrgrxr Camparry Nmne Doti 760.22 780 CMR Sixth Edition . 2fM8 (Effective 3/1/98) f. �e� t t r' � - �' ; ( � � � �� �/ �i � , . � :, , - , ,., �, �. .. .. - . ,� _ . - ,. R . 1 W � l� � � � � 'l 18'-St 25•2t (EXISTING) (EXISTING) (EXISTING) z ul c3 � woo 0 p >-LLJ Ld Q� EXIST. z �Q DECK 0 _LIJz N N 5 Q 000o ; EXIST. jn N W EXIS EXIST. EXIST. H �r EXIST. FAMILY O O I q EXIST. C/? d F ROOM EXIST. I EXIST. N KITCHEN I BATH EXIST. Z GARAGE � 4. EXIST. I colO l EXIST. V I CLOS. EJE EXIST. EXIST. w m EXIST. LIVING 4 EXIST. DINING ROOM EXIST. EXIST. PORCH ROOM H 2 w y N E%IST. E%IST. w E? oN SCALE: l/4" = l'-0" 16'•D't 26'-D't 25-6"t (EXISTING) (EXISTING) (EXISTING) i DA•rc 4 IMPORTANT — UPGRADE REQUIRED FIRST FLOOR PLAN SMOKE DETECTORS REVIEWED 3/24/2005 STATE BUILDING CODE REQUIRES THE UPGRADING Of Q SMOKE DETECTOR JOB NO.: 3>)05_ SMOKE DETECTORS FOR THE ENTIRE DWELLING WHEN T LE BUILDING DEPT. DATE W ASI-1. j ONE OR MORE SLEEPING AREAS ARE ADDED OR CREATED. LEGEND: DRAWING NO.: THE DESIGNER SHALL BE NOTIFIED IF ANY NUTe A SEPARATE PERt#JIT IS REQUIRED FOR THE ERRORS OR OMISSIONS ARE FOUND ON INSTALLATION OF SMOKE DETECTORS-THE ELECTRICAL O EXISTING WALLS FIRE DEPARTMENT DATE CONSTRUCTION. N.TGS HE BUILDING DI START OF TR PERMIT lO NOT SATISFY THIS REQUIREMENT. �- CONSTRUCTION TO BE REM `� CONSTRUCTION.TBLE FOR THE CONTRACTOR L_—J V�LI�SIGNATURES ARE REQUIRED FOR PERMITTING WILL THESE DRAWINGS I F ONSTR CONTENT SM NEW CONSTRUCTION C MMENC S WI ROUT CONSTRUCTION COMMENCES WITHOUT NOTIFYING THE DESIGNER OF ANY ERRORS OR OMISSIONS. Al L t8'St 25'.Z* 26'•0't (EXISTING) (EXISTING) (EXISTING) r EXIST. _ EXIST. z CLOS. z o; EXIST. EXIST. 8 N -- 4'X x 6'8' (� LJ O EXI N BIFOLD C) 00 �B N NEW C) >- 13: AT \ _ BEDROOM LTa m r� a F rz� b' '� '•v-' �Z N C/) P 00(n :O Do sf �s LI ©' 0 co 5 0 EXIST. EXIST. EXIST. J EXIST. f rs a MASTER EXIST. a BEDROOM EXIST. nH a ; ; WALLS&DOOR STUDY � U� �� EXPANDED � e' LIN.Q " GAMEROOM NEW AND.to 28310 WINDOW y LIN. W/3-STUD POCKET BETWEEN �4 EXIST. EXIST. ��` EXIST.WINDOW CLOS. CLOS. ON ©�a ❑ ——————————————————— E�K �iKYlIOHT y _-_---J\—REMOVE EXIST. a NEW 3O'x 48' IABOVE 177 ACCESS PANEL WALLS B DOOR VERIFY LOCATION . . O O IN THE FIELD EXPANDED 1 GAMEROOM � H� \PORCH ROOF BEDROOM ED F BELOW EXIST. EXIST.CLOS. CLOS. -------- -- a� w pQ � a� 0 06 to'-0's 26'-0't 25'-s': cf) O (EXISTING) (EXISTING) (EXISTING) w Z SECOND FLOOR PLAN z •SCALE: ©SMOKE DETECTOR 1/4" — 1`0„ LEGEND: DATE: 3/24/2005 0 EXISTING WALLS - CONSTRUCTION TO BE REMOVED JOB NO.: L---1 NEW CONSTRUCTION WASH. THE DESIGNER SHALL BE NOTIFIED IF ANY DRAWING NO.: ERRORS OR OMISSIONS ARE FOUND ON THESE DRAWINGS PRIOR TO START OF CONSTRUCTION.THE BUILDING CONTRACTOR WILL BE RESPONSIBLE FOR THE CONTENT IN THESE DRAWINGS IF CONSTRUCTION COMMENCES WITHOUT NOTIFYING TTIE DESIGNER OF ANY ERRORS OR OMISSIONS. A2 r% TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION ' ✓Map Q7 l WParcel Permit# J 1 0 S 2 . Ffealth�Division ? 6 —�y 4< r D to Issued $124d 3 C.d, U SARST, � dO � n Co6ervation Division J: V/7 Application Fee 7 FBI I: !; Tax Collector_ SSW MTEM i1l9UST EE 57reasurer 'iK t7 INSTALLED IN COMPLIANCtr �'� — � WITH TITLE 5 Planning Dept. iSl'O EWRONMENTAL COnE ANL Date Definitive Plan Approved by Planning Board �becE'✓Lurhl on�. ��� a� .s�v�fre Historic-OKH Preservation/Hyannis �""� ����^ ^�s d, Mvt_ C/iM 'nq e. ANlyd r be rvvM_ 3Bzch ✓1 Jr Project Street Address Village Owner &er-T- Address Telephone SD Iy 2� —3 6Y� Permit Request W Square feet: 1st floor: existing proposed 2nd floor: existing 06 proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation Construction Type &M v: 54,r_1, C-RP,nn& Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family O Multi-Family(#units) Age of Existing Structure Historic House: O Yes Q40 On Old King's Highway: O Yes No Basement Type: ga*full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) I -! 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 an7es Fu : Gas ❑Oil El Electric ❑Othe Central Air: ❑No Fireplaces: Existing New Existing wood/coal stove: ❑Yes UIo Detached garage:❑existing ❑new size ` Pool:❑existing ❑new size Barn:Elexisting ❑new size Attached garage:❑existing EJ/new size Shed:❑existing O new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded O ti Commercial ❑Yes ❑ No If yes, site plan review# Current Use - Proposed Use BUILDER INFORMATION Name Telephone Number Address License# Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE FOR OFFICIAL USE ONLY PERMITS NO: . 0 DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATIONf , I FRAME ! ®off y 3/17/wr INSULATION FIREPLACE t; ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL y _ FINAL BUILDING Al DATE CLOSED OUT ASSOCIATION PLAN NO. The Commonwealth of Massachusetts -- f Department of Industrial Accidents =_ = Office o 1,7YOSll9,900s _ 600 Washington Street --- ' ;Boston,Mass. 02111 Workers' Com ensation Insurance davit fie. ��r r 1. �,�,i✓1/ location: t rd �-'C�' ci ✓-1 r S'��a t,✓t,l L1t_S hone# �� ��P� I am a homeowner peifOrming all work myself. ❑ I am a soleroprietor and have no one workin in ca ac�ty am es working on this ob. wOlkerS CO ensation for my employe..v <:x.:?f; • ]::??:j;,?:'?y >}:;;?;r,.?yj:ti�}?:2•:4h'`."""'S i'>�•^�c;%`.;Y,Gc`,�:�4 to er rovidin ... ]?•7?:i;^a£:::< £.j::: $>:<< :>::,ti,?A: .4.+. ?.+] . v::�.. . an ........f+ rn.. { : ......... ........,:•:...::........;:..nv:::r..v}:{::;t?:4:...w:nv:::n,r.},+.::•ti+?%;{.}}}i'•:•}};:n}:r:? •:hkr.{.J, r,:�/ .. .....::.nv.:,......:?x ...:.. .,.,v..v,..........v r.nnr..•.:.:w..:.v:.::r.n:...n.-....... ,-?+:w,v:::•:::•..r:,v-•.. .?. h.Ya;^$:?+i'viy:v•-3}: 4;}., 4, .....r.n..:. .....r............ ::+•.,.t:C?N¢,Nq .... ......,....:i.,..:.......... :..:.v:: rr.r••, 4•.x:• ••n, rR r r4 r.,,:R}':r:+ .-:�{, 'fi:•:M�,.r;r..,+n4} �q..xzh.4..}; ...{:r:?.,:.4Yr::r..?•...v•^ ,h. ,:??G:iv$$Y.$$::•:}:•:.`.• r R:,4\: ..?:., ^'h i•.f4.v:•. ,}.v.:<?£•)}. <Cv:'C:::rvh+,:;•]:v::w:n}'•Y;;, L. .:r...... .....r..n••xr:r:x:•}:v.. N•:Y}:•;'•}}:•} ...... ..... r}r.....:}:n:•r.:?ti•}i::::.,++:.n,•r•.,.x.....,••.v..:.,....r. , .}. ...h;,.:•.G.AOY:rJ'•.v••} ++.{,n{K•.}.v.•v:t:. •:}%. .s..�x-:::.,:...,:}>::.{{... ,•r�+: .:+n::::::..... �.,•7:{.,,:•:. ..3c.:.+.,•::••.... ...C;+{:.,ir?.r::v::• ..r;;,ti:.4+?h.'i',''c4 , ?•:::r ....I...., ...... ........r.. .r.......r., .,..'r .,....,-..,..r...... ..n. ..<{.}..4.tz,:•r+•}•::.#.:•.+...... ..c•.ti:�^�$::5$$?:•}:•:+.v,:$:'<,-:.,4:.,.y-..c.t•:{:?..;{:,.y.::}+:+ .:.;,-r::}•::r.}::;r'.tiigc .^i{i6hr:.v, ...:.............r...,...r... r., ...:.r.,? r..... .--...,..n:{,...r......: ..,-f.,:..n•.�::....\.......... ..�:•::�:.::::::...:,•:??i•}};.}};.j:vxz•:,%f3}::}}n.:.r}:�{.;<Ry3}.^.•:: .,{. :::r:..,,! .:.�..•:fir:.,•::r::n•..::{.::•{.::+• :/..a.?,?•r•:.,,:n•:?r••:.. .,••.xfir.{,.........:::.:... .......4:• :.....: tR.4......... .. ..:?:.::�::r}.:...,.r:::•:::::...,,::�:]::::•:..,.. ..., .... ....;y..;:•: ,•:..:. yr.}'•:,;i;j+•',::::}'::•;' ' :•..:�.�]::..::•:n•....r.......,.. ...,;r%{r. +.rr^fir••:?:;u;:j;:•Yi%.j;::';'•4Y' �•:.r.:.,;5`]*•.,{a,-.n.,<h{.;. SIIIe'.... ... .:.:...:.::..,i:i:....y.}:;i}::.:•::`::::r):•7:;$$:::+..,..:{?.j•{,:?:,ix5:•:RCz: .tbY•:..t.r .n•.v:•;•••:;; ?'•%ti?J {•? {w, c;..y ................. .....::•::•:...r:.,•}:;:.n.n.,;:y}•:,•?.•r..::n•:•:• r.::.. �.,,,,;��:,�; ti:• £.. .r.?j2•..A., a3•; :.:xi,.. :�$i:;c}:?R4••$}z]?h:....t,,. .�.?�:L:j;:.>':7v,v.•:,.+ , '.�',t'+i;:' :R.}:�,;•.,.•�+••„<'',,c�•'+�'iit�'`ti:�'''}#' •x•rr.,•:h••,..,•:n•.,L•:.,•.,•.+C'r :{r.,}:{.}::r .t. •r}.. aX•. 't.-.• 'Y•. S. ...{.:r:'.:::r•. ..A' h •:h-..•..,..... ..a?$i?$'1,.;:v'::'•:v:.n.,r+,?•n:•f•::•+ +..:.v:::.'::}:::.:.tiR;,.-....... ,h•:.v•. .-.; nv .:nx•.•:::w.:r:]7:4}}>::x::::n. ,,r�++ ��r S,R{ {.. ......... 4... ,% .y..r}... .h... .................:.::::::::}::r•;}:•'?••.v::.•.:.-.nr.vv v..i.,..,;}.h{4,{j;:;�{,Si;v}}4{r\?:�ti!;:\}:ti+a7%:M4;3,r'::%h.'G•:4$• .F.h .�r:}.\\} '}i,>n�.$C??�ii4 •:}:.',•nZ.v:... .+r4.V.:}.£:R?".sc+.J..n ..5..:. ...t ,.�`„ v.:hv ...{:+.:.}.}.::n .4�n. � .�:`rxa;,.•. ,},y.; •r:.,a.,}:?:.::'•:•z:?$::}::$}'.f?+•'.•}•-}•,..rr::.... .::r:.?• ..:h•. r... .n,::{..::::. .....:... .....r..............r..x Y.... !,.........:..t...,. n.:{::}::+::.•........:.:}}:{.;%:•:••;?•z?'c{•',••''$`•}:}:•... +..}.... .}?.}yy'iyt}+•;+}:f3 .{., }.•.;s,r.:}. .:)... .;,;}h-!,•{..: ..,a..n,... ..\.. .. :....:.r.:..r.::...:�......,•:•:::: +r:.,yr{r4:.r.;,+..; }.,..;{.,Rr.+:+•.. r.. n{{.,.: ... ,-. ,'„?•:•..?....::: ..,•.a.,.,,,.....::....4...r ai"...i..,r.... :....,r•.�:r.r. .\.+:..tr.:Y?.....fi::•:}}}..may$}:•}:•}:•:.... ..S.::ti•rx:2.}}.++;y::.}:?•.;•.!!n rf.?:.�{%.;{:.3>.r...{r..�.:•)..,.t}rtt•}):1.,+.j.. r rxrr.v.,,..... f!:v3x;: 4:• :{•A,.}:}}:S{:.}4:}{•.vi.`.+:i•n..... ..:.;,r:::w::r:y.}3r:;;;j.}:•..:....... },�. `... fx:'•::!•:v. x..•{.??^i7^.,?.. v ...:.:.:y.•4,.:.. .h:v;,.,r.n.;4:n•:£•.5:::^•:?.••.4'•R{;4}}}:{.., .. .. •' f � .x.v:•a:;::�:.,. ....Qn.....,.r.•,..r.. .. ti t:;z.. ht� ,r•3:$i$:f:'r43?,+p�..;}4cit yri}ti;C;:s` .....:..:........:r.... .. ... .. ..:r•::::.}}};n4•.v:.+at•}rf:Nt;a;)],+'f•-:is?x^•.•:v+;•,'•$;•z%;??:;+. .�Yf•',;$%'-{? '} .`r.;':4,h?•\+x y $S..}.:r.. ::•r::::•::.,•::-ro:;•;}:'.•.?•.;•7xi{.;$''r):?-„•: ...:r}•.:•}r::,r....,.,.<t£:•$:•:•:.r.;..;;{.>.t+•:•.,• #^it•:.•. .<:�;:�?4•a:>.?,4. .;f An}•k`.••:: ?%#; .;:4::.•r:..: ..-::G•.,•::.•h•,+.:,.:{.;a..., .;�; };.,.};. 'i.,. 4.,:?... ..;....:}}::•7;:•:+}:}r:+•h• ....L .n h...... .x.3. .?i•:r..;,.n:••:..:...?: .. 5:,<.x. :..{•: :J., }:: `T TN, \•R h ... .:..::......r:r.:....:;:••..r: ... .,.r..,....n.......•...r:.i..r:..........:..:.. ....•....... ..}:•?•:;+J:•.;4n•:•. ......n... ....ncW..$.••$:?cv:..?}..r•f•`•::$??h•-„•i+••i•z:x;'\yo;.;:.},.L:.,ti•]•'c�'?:•};h?Rt,.v2rR:,••;: f. r.h{r:�]}...rx4.w:n•...,,,:L.n.....: .:.;wnv:x.O:v.,.••x:�„• x:r:}:,F,•}y.•:.,v„n'},'z+,,,+::.i. • .n ....t. v,.. .. ... •.?Y .:::r::..r. ..:::.,:•:::^•....,•....rri,......,: i. •rrh•...r.:Y•.j}:r.}•.y:.,;r{;.•iff••Y•.x-.; r.. ri}:•::.Z:.,•:.}...:::,•,•.v:::{..:...........♦•....:.v:::••:.:. ....4;.};.i;+•}:.}$'•7}.:•.,•::.:••.•::%.}........,.: ,�.}. ,w,,;:, ..,�,r�]•:}\a6j:�•,..,u..,�:$�:v r#� .ti`:•3n�.....?;.....n....::::.r}....n..:: •. r. {:,:v:?, r).}n.:.v:•n..n::•. •.•...nn.....n..:.,:..::.....n.v::`.:,,......::1.n!.... .nne:. ..J7+ ,::•h,.4:.r4::•}}}Y::+:t{}+::)•:j % '£t:.:wL t:f{7 Six.}q q{, r F..•].v..u:w:.v:n??.:•n:^:vv:...,...r.?•:}.rnri..n+;;:R::n•:r... F.: ::::v• ......v:.v::.,.•...... ifz?.a.;%?; n},.,{,/.:}::::.,,�^h.v.:..... •.v}`�.•:... ..\.x .+.>M:: ,{,:{£ }..:n?,::,....•v.v.^..•.4...r,:+.•::.::::n...,.::L.;.n,.,,{.n..,.:.,v.v.,:•:.r:+,:w•w: :..:..n..:::wv.v.v.r.:.:n m,.... {. ..,..,•,}::.....::::.,.:. .....::.•r.....,.i...:•::.:....rn r....::.:........:... v.::,.::.�.�::.:...:...,.....n... .......:::.!•.�:;•}.. hann:� i•.. ?n,{v::•x......•::m.v•.......v};.a•;...,..•hr::+..,:.;+in?w.:.v.{...,.;.,.;nn. ... •.v::..::}:??•::::•:n• :...r,•: .............. . r..r•::....x,r. {...v,a!,....•• x,,:..... :.v. ?•:::...::::.<•v• ......, ... .t..,r.. ..:::x..............::. ....,..,;�}••$}:.;+.;•:.,....:::•}•,{.,ix• -:., „•.,;{;; + �:;t£:3:Si.:.k:3:?•};'�!{G.•c,::t��'.��fu' r'i•:`v',+ Q ...A.. .,iR?:iC•:• ;4:�,•:: .:.�;,$;.:{.;5;.,{.aS.: h•r::>,{]{};{].zi; r.�G.;..Yn,:%:4%a'i r:.c! ?•r{:.,•,...2,C.:�? ..h 7;:f.::.. ..+. +.a : �fi}xRd• ...v: • ...... .. .: � ..:•..:4:v+';w:+4.'•}}:$'•'r+i$:??^:•:i:?:}!•'F.4i7}:Ji'f•^ n.,.......: .::.v:+:::..v.4}.:i;.jfi::a....^?•r:{fi: .... ......:r...v.r.n. ..n}.: .......:..,?. .,.......::L:..n.n..n......•v::.v::v:v;}::fiy..,;.... .., ..}}•..,J,,a x.,}}:$i%;+G `.v.t..•.tv:,,k..\.,••.£.;kr.a...4•: .+yi,}':•:' } h'a '•:}+i:+:,::? ...t. .:r.z r....R:.4.}....... ..<?k...::•n. :?•ftca.,.:,,..,••:.Y::!<^:::•+::•r::.�?.r:...rtr:••fG.. .nr: a. ..r...}.^::•r. ,.::...F:r::::r:::.:�::.........:.:r..:..... r .ry:.......h:•:••::.::^..vn•. .. ...:.•..r.,r:u•:::.:.r, .;,,,;.+....., r:r..•.............• :x:,;r ..n..,}.. rn.n...n r.v..:n.. .:.., n....3'rr. ,..a. .,•::.:i::._{:}:;:?{}:-x%;:v;;:.;{::.: , n..... .: .. hn.......v..:..............v.r.......,.. .Rr .....,.....3.:.,,...:�,.a\{:,...f +•:a:::•}+y::...:......;...y{};A;...;. .�.......v... .......... .... ..n.... 4rh J.�r.r.r?,.}}.n.........<........ .nw:r.:•.iv}::::.:n.:.. 4}::.:::: .vi•r:•}r-+:•}�•},:{•', .............:.:...........rr:•..:r>:... .,r,•}.........rr•..:...... {..:r.,,. ,•.,;r.}:?-:+}::•:::..........�::n•.::.....rr.•r.,.. ..-.:::::.... i .:h:........,.n..a.:a•:>?+;}}%.;>..i+ri+{''ii.%��:�3:`•}�,:.• %•.�}. x,�..,::,:.7:4:.:::{,:4:.}+Y•isr}r:i•}:'::rh,:{.:r,.:;{.j:yi..rr..;?.v.}::;�..}r....:,.:;.;x?Rfi: ....... �rlicv# :1i113uTatrce%��::?::'$?::3::...:.::x:;•+:?{,j.;:,.}^{t4}}. . .:.. . ❑ I am a sole proprietor, general contractor, homeowne (circle one) and have hired the contractors listedbelow who have tlefollowin Workers' compensation.....o.:.:l,i.•c'+e`•-s;: .}:;{4:.y}:.�:::n..a::.;.}:•x•::�:$:.>.::>;:;f<$.}:.}.,7..7..},•:?::.}Y.::'ti+{:+r<:ri•}.v,,r•+'47:.?Yrr.k.}j};»xv{•,�x•.?d}-G;.f++:n$'34:1;v'c.jy.i.+Y�-.'j?ff}:�xi:;:.•.$;hE4;'£`.':'h`,��•£,:y�:%..f�.L•�'•.•rSf..z.N.•'::t?x't.'<h•�L•�7� �in�1•a,� `{w•:r,`:?' ):�r>$t}�.�i h.. ..�..:j..,.? .. :)� :•.nx:....,,;,ti: .... .:..... }:Y }`.}..., v.:.;•:.::+'4:4::,w.vn}:^}}:?Y.;.}}:}}7:i:•.`•:v+ .w::::..•.;......... v.•:::w•.+.•,.r..Ax:.,.•.v. ir•::'.:jyy}�}•nv:},;r.%{•.:: ,.i:..v.?v ?. ...?}.R...a♦ ...i:r.•...+r. ..t: •:+::.. •..f.: '•�. ,}',4'•v :S{.\'F4: (•nfn .... ....}......:::.:•. ..<.rri.:r:vn:,:v:?x'f.?Or7:;.}...::.::^:,;;4::•::4w::::::.......•:.:ri$:iv:{;t4:;•;^•:::;•>:•}}y:� �}y r� .. .:w...• ....... ......n....,...n. ......... :+}:v7$•.v.:}•......:v:::.v:yi:i}:•:}:•.y;....:::......}.:::.:i:::.v::x:?v+::;}�.�}:•:{•;:..rR:.•r v\v, .:}? �\R+Y .,:Q•:,,, ..::f.:.4. ..t,:+.•.:::....n .::y,.:..,.. ..t4t,...}.4r •n<.:rnr.•. +c£:?• ?::4••+•9�:•^•.`$: .).r �R�. ,.z)•. .. :.r.:•......::.... ........ ..r.N ...............::.;:.$:•..........::::.}:•:•}}::•:r}::;t•>:::: ..,•.. rt?• .. .a?: ,r:. .r:r.c•. .✓.]. ..r•:..:..n,•::: ......}}::.....:t..:rr{:.: .. ,,.::::.........:.?•:::.v..,.. .,::•-::•}:n•.... ,.....::••r::.Y.?•z:;:j;x•?{;:...:••..::{r.;::• .;�+, ..Xr.:.... :.:....n...r..:.......)..a•:r.,r.::..,:.>tr.........i•r:,.........{.}..Y..r... ...??;ta?•.,•::).}}}}::•.;•}::.... r.,x:r. :....;.r::.>'�-r'.{Y.:.:::::^s..n:.:�:5h?•:..,.:,+.%?%??t.��.+if.•.}3{ry £:,,,�$?...x.,.n;. ... ...rr .t...... ...n•:•.:•.. :.... ........47:.^':.;.;•f.••}xR••:;cn...C}:?.}.n•.�:..;•:..:... ...r:n}}}::.:.:}}:•r>:•}:.}:•::;•}n+ i:•h.....rr.r.,r..:4.,.. r „.}.?•::,}.....:{.. r,.?.. ,c.nrr.: :....rr.,.n.,., , ,,.......:;..r.......,{::..,.... ?3}: rn,.... ,.:..}h:;•:.:�. ..$. +7?:;i..n........n:•::..:4:.::.:;•:;{{.•r:^?::•+7••::.:.:r•:;:•}}•:?.. .. •' } -:}.::nv:.,,•h{O.sx,.•,:::::::},. .. .. ,•::: .. ... u: '+ir.'+.i':r?jrc,'.'j:tc•#{;�'i; ;;.4t"q�%r'k4"n'�%n'+"..��+'�F .. ::name..... .. .. ,:......•rv:-:::•::-:::::�•:<:+,•rx}:;•ti•7•.Ni:;-.;$•i';•}}--.....4:+••x{.}•R•::••: r.....,.: ,,••, ., 3 .< tyr..ni4]"$¢k?ai:.}• LOIn an .............::.,:...,:..:::::•:.��::+'nn+x::nn..+...,.:w::fii}.::r..r:....,n r'•{:,, .. ,•:r:.t;;.;4??:<;?£?!•�•W.;.r}�{•,r,;+}7.R• •`'tr';}�:}:::v: ;4?$�:. '�i) R?:h;�`c.�';:k •:#?k:. ....... ......::.:•.....r,... •.r ..},,::+n?::.. :.+.,••}•:i'•:..t:.r:......r:.,•:.........:�::::?:••...,.,::h+}:;;$$:$:}:,•:.,.•:::...h,J.;{.,,+y.r. k:'$h.:r.:?$$s+`:< d +L vk... .. ,.. x^; }t,•:;:: ,x r: :•.?+,:....;.?.. .>w•.�::i•:•• ..f?4?:::::...,. .}?.r. w, •Y..!, .,,:.,•on•#::4,x:<j ^ ti�tr,?..: tv..f,} tnk•`r ..}.x: :a:a]}•.,t;.., �-Y•-��r .� r.r ,+Y:;R::.•..::r•?•}:•w}x!t:..r•:Gt? x<Cx••.,:: . n.f. �i :}:•'?:. <;4•}.•.+.vn,... .. ^:%::i$n rr$>:f}.j;:.::....+. ,N`+' •4.?.. ry .:h .}:;: .!r,]i•. •t•.. Rr,... •t{,'-::}:.;•:.};:.!+�:�>:3 �:�s?::a::::::•.;:�:t`�:i <` S�r:��i•} {4:... u ..... +ocv:tn• o. K}}}•: Nyr. w �.� )'•''rr•.;}:tx•.r.....n:w.v.•::..rr •.4r.4. .n{'3.�$:??$!' ...U:>•:r-.•::::• .:.hvw:v::J.•:-?4:4:::-::.:;:.. ..:{�: y+Y• n rh+:•}x<a+.+. i.{w.f+:i+•j�?•. .r, nv::.1 n.::::]•:$:::'4:'+4Y? 4..:;S�.,Y,/.•.}k 4.<::iiY?!•}::vv.J-.;-v-v.!Y,•::v,:x.,...y;,.r.{,S-...n.$}}:4'v. ..:..r..r... ' r .n ..:. .r. ...f .n:^.:x?v.,••rr v:r:+i.w.4:?ay....•+iv:r•.,vv:f.•:.::w:,... :i•::?:;}:J:;??::`$i::$;NY,.;y$3;}$�O,.xt.x, .r 44:�<v•.:.h�.?.::xarin:•.,-.?>•h�•:h{�x•+ i•+.+•n•.•:}.,.;,n}.,..x....a..v.. ...... .. .}+� .. .....r.:r:.::::v•:-.,<r r:�ax•h}`.`i•na:•x••:,...�•}:.-r:h:}.,v:•....Q•r???.%{. .. ....... ... {+.....:}?.;r..{F:4n.n•. .,........... ::::•::.,:••:?;?•::.:.:.;.:t: r,.:,4}:.:'•'+':i•`'`?3 4'<i:':•y'4+r£::z}Gti waY)`x •fi%. ?': E�teSS.: {+;£4 .?:.f•,$v�•4! }�,r:: n f.ir:•.,}3,.$ �.,, l� ;•n.:: •.t•.w:i3 }%z}?•`.;:4r3:'•h.:}r•:..;. x$>.....r.j .4 ,t^% �}'�-i,. ,: ••:+.?t':z ,35'',. .L::G;`:> }r:::c.:}};Y++•.t{+.•:}:}::a{: .;;?:i:%$; 4:;,::. }.:�{j.; R }j}• a)x• r:.:<.,.}..rua:h. r x3 :• •.? . •:?a}ir•Y:•:o:;;:a .f?.. ,..a.•,::: •?+rr:•: rf•n{:::{{.x::;•;.<:?r:? -:rn rY.fi$ rt'�..T- .;,aY.:..:.r.. .<r ' .::... ../.. .i:•^••$$+::::•:xr.a:^,-:?:},}rr+.a•.4.,, y •.}x•.:'•:�:rkr}}» {k�.. y A )$. r: ?:.•+ bt ;.}:4'?{:+Yi•}:: ?i;•}}:}r}} }.a •W.•:v ::K,vr-:•::.::4.:r Y:S:vYv:.v i+$:,... v.•\-.:?�} .,Sv,•:J•.'J- y,, ,¢.C' : rr?,r).•?r:•}f 4:r,$..,... ..}.. ..£....:..{::: :.,{.;�:}vn• :..$.. ,.r.t.r.),.3;%•}.%, >•$} ,,R'�T; �yj'?'>r2:`••• !•.vr .?`..,}nn• a,4••:y}y,;${.$i:j:<•'?:�$'Y!`..,., •;?{?+:$$i$'•}$$>$. { ... •+•i+i:Ji`,'r• .�i, Q J .Y•:.+.v.$}] i '{pv{':{:;3: x r.•r: a•Y}:6h,:£•j: ..y?n,•r. .jr'^d'i,r.?;., fi..; :.:r::t :zY ,+r'.`•? r::•?zxz•}:{4;oix?jry:}{- •r.•r.,.,.; a:•. r3];R.{,R•rr:f;•+.:t•..:....r,r....r...R .....?SF'??( ... ,..:�•.<5,:..$k•''N•.,:-:•:3S•?Gf r...,.:?. .. :t•:}....:;: C ��]] y}�q• h •. # ,:.tj}::},•? -+^},;$3+ �iQnC:�f.:,•..,.r."j?'v'GC:r. ,+x,�`,{$tt;;,.f. t},x?£:!yS:,i3.n+}f� ... .n+:+?}:^}}$$ry}••:n{;.j}+f.,r }••r4> `ha 3}.,.}$:...,{..{�:;i?:s,•:,�.::;:r;:.f.,,r..... 3...,... , :.... :..... 4;{ 4i� S „.. .:::.::r:ihv.x..:.v..v:::::.:• - .x:•{+:rr>•'Fn'•:n{;' 'N.jviir$. ): vn?:+•fr4.,a,v,y}y$:f4:4 w:}.{!•{?£;r+`Gn.:F\hrSir�.,hfi:3'r)�:::.f:\r.4;,•.$�..,.r.n:.r.....rr.:{{:�. .. f .....•.v}........{.:.r•.,,..r.}.,S{L4n:>.:vnv.:}: .... � v:v+•, N?��• .......}...r....:., .. .......:.......... ............::+:•}:{4}i}):•yxy::'?%:$$7:•$i}:•7:�:i•.:':�• .a .. .C.:4'y?•}: ¢'::�i:';�R{r.?ro:ry,f� .,:^.:..:....... ...... ......;....r:.,•.r.,•}:::•r.•:••r•r:••::r.NL;++.,•::}::::r:.�..rt•:.,•::: +r.. a•• \:,<,.... ..........::.�..,...,rr ., ...,,....>rn a:rr'.r...... ....ri:•n•,--:., ::•'.•:::.r......,:jg:;:x•:•y}••::.`;ti •:$J.•:..!y;, ,r.%, ;)3�{'•i#?j7y;y`r'::^{;:Sf`,.• £7k.',. rh• ..rrr.r:,^ : :..<.};�r,w:y. •........ Jo$$?{i i':+r.r..tR}.-}...•.X,yF;'n,. �;x•4;$x}. +i% i.tt?,•:.?.{f, 'z,?�'`� .4 .:%'.. ,f 4 r{;??'2;Z.Ft2 y?{.;x•..vn%+rrr:Y $6 :ffi<r x,y).;y ?•x .{$ra ++3.. +,%..J; ?...}r:: .n• 4W' ;.tx ff.. :/. A \ 4�. tea, 4& r0':.a••?:; rr:•:<•;,•r,:;i„??}'+.i£$:?:..;, ,. <$l.; nn:fr.}:•:.v:,.:•v•.,•:}.{ :,t;Y.-. ...f..•:..... h} + 2• ? 1„�4 },{:a . .:.,{.:•}•}'4 x;4 to 4:. ::£:C:-.p.. +::^i:S??%•+:fir;.r•:r:4n} ..rr:£%•:tt;n: }z.f},••<:?$,4 .n3�,k,. ^$F:?,{ .f ar.�+# .49n,!dr.•r. •4:x••:?•:.. :•'•• ..::•}!• 4 :r vlfi'iM.'•+''•:i{•:^'r?::ri{:.i};:'f.+vr::..n}rr..,. .:.}r:•'vNri•};jv`:.':-:;t• SY::f sr.,.:: •C;`•`.R: ]] ':`+3.`., ..h?•.3:...}ra'x< n.,n,2., rr.•:.r{.;r.;..+?''$a�:• ..+ v. Y•}}r:fir.Y;.n; .. , .v.v:::: �± !•�F.'•":i:+:,{,v+,}?: , .}: ..tFx•:?:ar{t;;N:??• +:�'r ,{A, .r.+C,rN.+,++:�^�'$.?`:•v?::xo{.{f?`.S%};r�s,•;x$$::i'£�{i::� :%+"}::;?f\�:�$.xy}f:a.. {+n dLLC�' c.,Jn•.a:..n �. r .,...:.+.•:::•::�k$f{2r;:�,, {fi};•,r{r mfi'R+ + (n•, t ?� ws. ,+ ♦,^{ �:},w..., iYntarteeco• :::.,... i$ji:tiv.'{.;;y{,;d.;.;.�..`ja�+;%}:{;?�u,�;:$4:r��o;'"'n;;£s•�:}.,av,.;tr•:•,Q:$},: Y?>4;.'>v';•'.;.;r�£3: %'�>:�-::nS:`:.{•r F•fi::.G., .:G.4`,r•.{..£;:.:{,{+v;,�y'G,1. �+v'ab:+,}ti?jy.>??r.4.r$,..fy'ry^^,2:: .r rr....,+.�.�r}•�-n.:::•y•:r:.:.:,.:j;}:.r,.,;.?;}}$.f}a:: : t{•}.•aa•:+r.}4;•••<?,:`.4'n?:�}}•...�>.c.d-i�i$x•:rfra•zn;?.r,;YtSf:} <:2'•r'%}'•r. R'43 �`C•-}• \,r:.,S:.f, •yxc•:ai•+•Yr:$2R:•}irn}.,fir;r..,}{;.,4 >?,•:::r..,..,..n}:.,•:...,...}:•n•::}.:!.::f:.,. ,�;.,s,,,r.; } •r.'a rnr ,..3:.f! ,r {f...t {S 4-S .i;: w%•}ix..,...r-.});; rr.r�..,..4'tr... .,twd: i•$v•.::+:x:•:jk£'•:'?:•::;:>:•5?}: 5:4}••.>.... r. +t3•t3'•:.v;{•xa+• .,?r,.�.t#... .w{ %L>:..+rz�$:�iir:}:.. •:.rr•.•r..z.:. .:./?4.{. ,r.a•.. .}••r:x....:...,r:?..:.:.::.., .rr•,4fn:�+::]�\}.•.. :r.c+. +,• fa•> ♦x rr:••.,):? .....r.,,. ...+... rna:.,1,.. r.::...t,a:::•r:n•:., +:?+•$1:,•?•}x:•::.:.. ::w.v:.v...,.... .:,-::}:n•:}n.••::•.,•::.:?•::c'.`a?:{:,'{+'?J'...., T}rF�' :�+'�:y:••2a}:?,•,fna,�. i?$•'•$} },�:w�bfv�:h�''�}.- .:.•��aS.?•`.• ,?n,..}hv.ay.4•,•::v'!•$::•x; ..{.:.�:::i3:n.•:rr::•$:.v.v:::}.h},• .,•i. {{.i{;'rK}4{,}i/iF$)4,..}fi}'n,",}h•:xL::\,:.h.}n.,v,{S;}+.n.,',Rv4.,.R.�+.x. '4....:rL.... .....: ...}. .R../.:r. r.,Jr. r.n{...r..r....r .x..v..•,....}.J:v?•}:,•\•:{v;:• :.•.??%£;.}n:,•:~'�G:';}:.):•:tii.4::{%�'?a'•::{�`y-.,.y,f:',+.:..,. :.}.•... ..:)•r:::.,...:{{:,i y:::.:.?x•n4,.G... ..,:;r;u.{,....;}$,:r..{..r.n.:.}:r::::.,. \.ir:•:••::.... t:.v:}:xr:?::.w::}:::•:nv.... .•-?:::........+..n n.. ;,.... v:•:6.`•'{j{;$: ':?v:::::r:.•::::.:.,...:... .::....})r..x•):i+•.vnr:-.rx+},,.;{.:.}:n•.,•:::nr,.;.f,.•..,...,n.)...:!:;-}.... .... ...in. .... .{:r•:r r..,.,. ,w..,n t:::?J..............n,............, ..... .v•:•:[{n)+'{{.Y:v,•r:;r{.:ik r}q?:,{v,{:,v,:4>:}$t'hti}'$$'Yh.+'G'$:'£•?,SwC:%,:ii.$tw��L••:'r.•`;ti:',£•}. '�.'}:.;,};+�.`},;? + .,y Pw:?:v.4:.^Y•lr.,{v........n...' n::;;i;}:f`.}•r.x•.f{::�$'ti3:}}:)i; hi%'?£•{.Yvi••;}•.}i}{+:f:}ilia:{{.. ,:,+3:n\•M„v:;Y3t.%4n.r. :Yiv$'.5�:;�n gh{x .::•x4:;::?$'{•}<:$iT$$:b" x:4r: ...G,,.},£?:,r r.<..$.t.::+;.+,, \�xv. rc\:�i]• .•R44..n, ..,;.., .... .....:...,...;. :.]Y:x••: .v ..,tr. r.. +:++.,. .:;}::;�;}:•i:•}x•:r ,..,.::::.::: {.:n•:.?:.;$::•:}.n-..•r ................n.....r . . . ..nf.. ..ir ;?'a.:.+rx,.}::. ................. .:n.r.+}:}}}:•;}$>:;:••r:....•7,..a}.x:•.fiv%•xx,.;?a$•�4}+.-`•::�i'q':; :a•;{,-::::n...r......:t;;• r?.af•.!>:•.a�:,{ ;; •:,t4.Y,?{.a;h3}:: ..anx•zK ...t. f'.:Sr.n..r.h.:..:,r ...$. :•tx•::+..{.. ...n:ti4••}:-.?•.. ..{.r.p,..; .h.::::r•r •::)r :.J.r..{h`•{v..:. -.£: r£:}•,h.},t•. hv•••v{n}}:•:•,•r••N•}$.:h•:::lr/.:•.`f. ..n..:+,•:]•.....r...r.. ..n., ..r..,:.,erv:f}}::.{•.v::Y.v::>:t•r.......tY.....:v.}}}:v.:.:..:.....};v.v:•:�}}}:? .{ v..i'•xn, ...4.•}+ :Y... r•r)r.4 . .:,\:i. {•. ..hv•:.. h:..:Y•:n?.. .:.r:....,,,.•., .:i?'•YR }L•.? •�?.a, ..L4'vr.. ,. ,,...:rr.;, .n•:..v:.•r�•:rr ...r.. ,.:.v.{.,•.•.w.•'ax n...•:.::•. ....?.•.•.....r+.. ii? ..r... ....x. ` �r.:..�:.,•::;{{..:::::::;{•:;;......... a.::..},::hz '`: ..}}.:..:... ,r ?,;i: }::?•,; •hk;)+?,.,•••vr`:4fi�6r.f 2.: >'•:?rx::r,.�•j#'•::: .{:fir...}.v•r: .......:?•. r:+,.v:y. ..vr}>l,•...........:::},........... .......,.......:.....:}.... ... .r... ..v::{n .SR.,..f ..........:•... .:?•};4.....r...;,t•::r:r::??v:Y:.... {..:v v. •r:},...;ry:`✓;:.vna}3:::::}yy.vL•.w:x:�rx:r.�•?..,,:+i.r.).nh..•!>. • n:.,:{?.+::y}:•.....::..:::.:r. ...•::.tn.+•rtr.v.v.,n...::•:.h??..x....}:•y:tt;:;?::?4"•::x.... .::v:....•.:.y'.v......•,::.::., :.,<.: .....rh3?:•xv.S....:::.r..........,}.:•:•.. ...:::n:.......J...:!:•:;.y:;..<•.v:^:}•:v;, .av::v;-. .....:•.........:+.... ..r..r...?..rn•.x.........}::::....a..r:.,:.... .....:....t.v:r.............. :.:r}r+:::•:t•::t•}:::.�;:: r.....v.+.vhw:.,::?+•: ::;•:R:vn!•n+•:•.:?:}}.v;w:v.•. /:v:v 4:n?r{?.::;}ry::.v: •:•: ....... .....r .,:. , ..:..r..... ..........:.::•. ...,..r.:?:?.,......,... ......::•.-••.•:'•:.:•:r:•;.x•}:;.x{{•{zn•}y:•::}:?:a$::'ctyi?j^$9;%$`.`??%$:•;:{;jvk' 23<$t'3 :j' �»•r:`.v+,4Gy]. rti{• ................t:4:...r.:r......:.. . ....:: :•::.�:..... ♦.,,t,•::;;,.. }t$�•}}:v:,r::...v:::•+::::•?.}:,If.};;?r..,,.., .}4y(p, ,h' 7y,;k<, •:•+ti::.r.+•.<t-:....n.;i`,,r ..r?-rn•:tzz?}f.:.}fi+:•,},,£.}„,}.,{:..2:.yti;�•G,?•?,]`+i;zr.5}�{;.n. .. ..................,. ....,.•.,.r.. ......,.................:..,................. ...L.::.::R::::•.;.; .........,.:`.:•.R x..: ..i.},,:•r. .r. r ••',;}¢£7.!:, ON n�..; tr:q•:j?$?: ..............................Sr...r. .,. r.}.......... :... ,.......n............. v:r.:.............. ....x...:r. n•+:�.. p .rfi:•. .. ... ..r..... .......r ..... ......:::r•.... ..::}}:::•.�n:••ti••:::...:.:......:.::::h::•rx.}}}}:•}:•7:•:...::::. ..•. .. ,f7.•: + v;/r.•. }.,... .r..... :.r..$ C....r. n.... .. .... ........... ..........•:n,,...,.....,•^,:•:•:....... ,,.,?;,r`<::,)v%zz`.vx}^i):,`?£?i`r:,%-'$i .+�,..yA-?�h... ..n•::......:,vn••.......•.v:n...,... }.::... .;.;,-..n.........:::::..,.......r. ......x...::::::r:. r::n n.,...x:::w;, .a yy,, Y. . •:h.. r....::....:...:•v...r.....•+•. ...r...x:... ...n:::rr :]...+r:::v::x......•••.......rvv,{.vy:+}]:.....:.r••.....r...%?L•: F.?•.+.v-.}:•yr:Cr'.}:+Ya:{,nv y}8.};S':.:9:`.x:}:?•..v.h•. \ `4Yw ...;r,?ri..:::.n:?w::::•:•:.v:.,:.......:r{..,:+:•,:• .};r•::. ...vn}:{•}'.:+?..?v.,v}:-:•-:^nR::::n....r :;}.;•,.:; v.iv::.... v.....: e ......./:.. .:.��h ip... ..+........:-n•.. ...}}::}n. ..,•.{}ii:•x: .,..,.??..:.v....r....i.,..r.:.:•:::.}:.:.:•:;•�:•:;.fr:;:::. ..}"?�:•;!•7Yf�•+- :•x•:j;;�:to;�:}r.:;:{.+ .�;}}.,g.,�.,,., ..r .r r. ....................::.:v:;..::!,}.. :i+r /'7:.rn..r.+}.C}•.,�i,?.?:;?i{;:} ,}h 4.x{r:;:}} v.< .t1 . ...r.}...r.r.......• ............ ............ ...... ... }+•r+,<4?r.jti i'�?}};.?;:?^r.?!;:.,+:i::: f,:•}f'•r.:v>.n, . ................ ... ...........r vr......... .::. ::: .. r,,. !.r.x:x•.v..:}}"}:t?:??:$:Y}:;:ijJ•:?ti'::' .. :.,.....n:Y.;,fS•y.L;j h:;•:{,;,?,:,}„ ;};:}„ w,.1:•y v?-:�.:v;r.;p,£i:a,. ...... ...... ..r.: r•:r:.::r:::•r::••::.r;r.;;t..::::::i:+c•:...x.;2z{.:;¢.;.:•::•:.}r::•:.,•:r••.:J:.•r.....;;<.;.;{{..r.;.};;. :n,• ,•r}.,.;$+..,r.'••c•}.,•:•}::::. .:•.a:i••{r+,a.zt.••.,•., .{x c"t. .+•.',:<; ...........r..;..,.v:....rn!{•! ., ..fr,.{..,•:}.. .{.:.,{.}::::.•r....:.,•:n+:rrn•::.?r.....{.;}:.,-.�:}....,..:�::.}.:•::::r:c+•::•:..,:.o:n{.n• ,Y.t•:?•.,...:•.:,:r•r:}r::+•.`•:4:•..t x?.,•�y:n• i.. :�,^i,`,{f^}:�, �a}fn r?•r.....?q.}�•:r. ••,r...i...$..::::n•:::}: ...�-:•:.,.. .,r. ..{:..{. +:rsir:,}, r.{$. .%?n•�n•. , 3..r .,•�.kw•.::f.. v w,r,r••:?•}:4%{•:nvf v.•`.4:4'n+?x'!v'+1•....... .,..x.fx•:{:'.}$.+•:•}•:v:::N.}^?vn..:.. .... L.t•:. ,..v}}'fi v:;:?:?};.v..n.•`}:.x n?,•,\ .rr }.• ,.:,. :�t<•::r:....r ..r., .:•f Y .•F.y}}}7.. r•nt t.•••�{+,•.;�:.�.. ..\•Jv J'Y.••???�:�,r••}•`kq;.:�•.,3:•:: :+:•r•:.:!?•i•:r:,,:•:::::•r::n•:•r+::.../;.,.:•..,n-.{,..;{.;:•ry:•nSr r..,.} ..+...::•r. . ...,.3:... ........ ..:n. .r.,.. ..,.:. .?•:,v{%;?•:;+•}:.:..t•:•t•}4:i%•:r,....::n•t:x•:.,•]:?i;•;;•:•:...`}.,.r..j•:a•^:?:r:::::;.., •.t. ..;..:�:::; ..n.....::..,.:.,::}:r .x..+:}$ ...nr::r:ax.t,. , 4.,•::..., +c.:.. ••:...• :,r�• ,a:; }.. 44 h�+Y£�' ,K > '.4..:4, . ,;,{a,x...•h%c:-...•,r ::^:.rr.... Y`.-..•.,•I`:'••}•: n...fr.:$r::.............::•••i:•:t••}r+}•+<•:•krrr+r+4x•?.:;. xa•r.. :.}h4kr. t ' :•{.;},:v;r,}?£?,•,b• }��;o:;•r.•Y�£?�C;:tJ:i;;,...:•:R•a•.•\. ,..{•..:v.,:....::. .:,>;r-{..L,Y:•:::...£.,;r,.�{..}$:a':}:Rj},w$'fin%,.s•::):::•Y$:^:?-•rry}:??:R}•:n•...r,%.:n?a;•$r?i••}}X},.{}..;.;,.r.+..}}•:{::::{..,.r:.:.}., ,t 'r?;•?.)x?•.'•ifiiY:x;Y?.•:%:?•::•••:.rl.:..��,�{:,%..{]}Y 7•r.}$,F.%{fYri-,::{.'•:?4'$z%.?•.:,t4:.:a:{.r:x•:.r:}n}.+•:::n%.:.R:,:n7•:?,?::R:•}4.{.:x:��ti;:4�✓::': ou' IL1II$�1.t6C:COi�i:i$R:.:n•:.:....:n,., :,.. +t gy�nr a to secure coverage as rcgrdred under Section ZSA o[MGL 15Z can lead to the imposition of criminal peruddes of a tine IIp to SI,S00.00 md/or One yam,imprisonment as wen as civil penalties 1n the form of a STOP WORIC ORDER and a fine of 5100.00 a day against me. I mtderstaad that a copy of this statement maybe forwarded to the Me of Investigatio of the DIA for coverage veri$cation I do hereby certify the pains penalties of that the information provided above is trtY and correct Date signature r Phone# Print name official use only do not write in this area to be completed by city or town oMdal peradt/license# ❑Buffding Department city or town: 014censing Board ❑Sdechncn'i Office ❑check if immediate response is required ❑Health Department phone#; - ❑Other contact person: 5155515,555 OrAmd 9195 PW Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the "law", an employee is defined as every person in the service of another under any contract of hire, express or implied, oral or written. An employer is defined as an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual,Partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer. MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or'renewal of a license or permit to operate a business or to construct.buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally,neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority. Applicants i" Please fill in the workers' compensation affidavit completely,by checking the box that applies to your situation and'` supplying company names, address and phone numbers along with a certificate of insurance as all affidavits maybe submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and L date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the"law"or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. City or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the peimit/license number which will be used as a reference number. The affdavits may be retarhR'io the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would Like to thank you in advance for you cooperation and should you have any questions. please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents Me of lavesugatlons 600 Washington Street Boston, Ma. 02111 fax#: (617) 727-7749 - nhone#: (617) 727-4900 ext. 406, 409 or 375 r f OFtHE�p� To" of Barnstable 'Y r Regulatory Services _ Thomas F.Geller,Director - F p ��°� Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038. • Fax: 508-790-6230 Permit no. Date AFFIDAVIT HOME IMpROVEIVIENT CONTRACTOR LAW SUPPLEMENT TO PERIYIIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which.are adjacent to suchresidence or building be done by registered contractors,with certain exceptions, along with other requirements. Estimated Cos / eoeV Type.of Work: Address of Work: _ �1'Dy-r",:2,- It.ife Owner's Name: f�Y/�Y t yV �G Date of Application: I hereby certify that: i Registration is not required for the following reason(s): []Work excluded by law ❑Sob Under$1,000 0 ding not owner-occupied Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner. �`•� Date Contractor Name RegistrationNo. OR Owner's Name f RESIDENTIAL BUILDING PERMTI' FEES APPLICATION FEE New Buildings,Additions $50.00 Alterations/Renovations $25.00 Building Permit Amendment $25.00 FEE VALUE WORKSHEET NEW LIVING'SPACE Square feet x$96/sq.foot= x.4031= plus from below(if applicable) ALTERATIONS(RENOVATIONS OF EXISTING SPACE square feet x$64/sq.foot= x.0031= plus from below(if applicable) ACCESSORY STRUCTURE>120 sq.ft >120 sf-500 sf $35.00 >500 sf-750 sf 50.00 >750 sf-1000 sf 75.00 >1000 sf-1500 sf 100.00 >1500 sf-Same as new binding percent: x.0031= square feet x$96/sq.foot= /456 93214- AW 41* 9Z A,007� �1`�1• `fy STAND ALONE PERMITS ,. x$30.00= Open Porch (number) x$30.00= Deck (number) Fireplace/Chimney % _x$25.00= (number) Inground Swimming Pool $60.00 Above Ground Swimming Pool $25.00 OQ Relocation/Moving $150. �f yy► yY— (plus above if applicable) Permit Fee r _ � 7r N N m s f�- 4 l .� kC) 6 0 � LOT 18 pO 20203 t S.F. VENT + `0/•`�` N. ,5. `' y6 PROPOSED a�• ti0 �� b�• GARAGE 5 s/ � p1h6p 9 ti 6�. PROGRESS.-:PRINT DATE THE DWELLING DEPICTED ON THIS PLAN WAS LOCATED ON THE GROUND PLOT PLAN BY SURVEY ON JAN. 8. 2003 AND IN EXISTS AS SHOWN AS OF THE DATE OF LOCATION. BARNSTABLE, MA . SCALE: I '-40' JAN. 16. 2003 THIS PLAN IS FOR PLOT PLAN PURPOSES ONLY AND NOT FOR EAGLE SURVEYING , INC RECORDING. DEED DESCRIPTIONS 923 Route 6A OR ESTABLISHING PROPERTY LINES. Yormouthport, MA. 02673 (508) 362-6132 (508) 432.3333 THIS PLAN IS VOID IF NOT STAMPED AND SIGNED IN RED. 0 20 40 80 PROJECT NO. 02-145 i oFit+e rq�, Town of Barnstable Regulatory Services BARNST"LE, ; Thomas F.Geiler,Director MASS. 059. .0 Building Division tE0 MA'1 A Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: 2 JOB LOCATION:. number street village "HOMEOWNER": na / home phone# work phone CURRENT MAILING ADDRESS: C i4/il/Lc city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with.the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and re ments and that he/she will comply with said procedures and require ts.. Si re of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larga will be required to comply with the - State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by j several towns. You may care t amend and adopt such a form/certification for use in your community. Q:forms:homeexempt 1 2 3 4 5 y BA- A DESIGNS D D Existing Building I ❑❑ ❑❑ ❑❑ ❑❑ HI ❑❑ ❑❑ ❑aFE HI o❑ ❑❑ ❑❑ c Right Elevation c Front Elev-ation 8 �° Z'BOjBa B 2.4.w t.�,t.Rt WU.A t.JWt al0o,e.c 61 TROTTERS LANE Existing Building 2d Plot. 114"=V-0" A A PROJECT NUMBER: i Cross C t I o n ISSUED: BAW 1, 2003 Rear Elevation DRAWN BY:: BAWA CHECKED 8Y: FILENAME: - �y Al 1 2 3 4 5 1 2 3 4 5 26'-0" 8'-0" 13'-0" 5'-0" BAWA DESIGNS B D ' I I o - 2 8 Plate Bolted to 3 1/2" - _ O O / SCOt Zl--Floor-Plon io a0 N O Existing Building Existing Building LO I C C I Second floor Plan Scond floor framing 26'-0" —0"3'-4" 2x86olted to Steel Beam Ae 19'-8" Steel Beam ;-c B V/4 iay.-d S.—d"o/c B c encasement for Beam s c mill Lally Callum Co t ia—ate►t L.. I I_ ;•iiroa.r o Detail Around Beam Details @ Eave i I I 61 TROTTERS LANE 3-1/3'Wly Cam. Garage CND yeti 2e6 pressure treated 7 �+ ' 0 F. _ i 1/4"=1'-0" �,� Existing Building :: `" O A ISSUED: NUMBER.. JULY 1, 2003 DRAWN BY: SAWA ;�'• _. .. . .. � Fl ELENAME•BY- Fdn. Details - cross section d T-0" 11'-8" 7'-0" Izo 2 1 2 3 Ground f to r Plan I L.F.GIAMPIETRO ARCHITECT P.C. Registration# 220 MAIN STREET, SUITE 101 FALMOUTH MA 02540 7124-1030 Washington Residence 61 Trotters Lane, Bar nstable,M Garage Beam Date:7/03/03 BeamChek 2.3 Choice W 14x 38 A36 Wide Flange Steel Lateral Support at: Lc=7.1 ft max. (IY Conditions in., Min Bearing Length R1= 1.1 in. R2= 1.1 in. Data Beam Span 25.5 ft Reaction 1 9410# Beam Wt per ft 38.0# Reaction 2 9410# Beam Weight 969# Maximum V 9410# Max Moment 59986'# Max V(Reduced) N/A TL Max Defl L/240 TL Actual Defl L/487 Attributes Section(in3) Shear(in2) TL Defl(in) Actual 54.60 4.37 0.63 Critical 30.30 0.65 1.27 Status OK OK OK Ratio 55% 15% 49% Fb(psi) Fv(psi) E(psi x mil Values Base Value Fy 36000 36000 29.0 Base Adjusted 23760 14400 29.0 Adiustments YP Factor, Lc 0.66 0.40 Loads Uniform TL: 700 =A No. 9$ FaI outh ti rt�A cS 0 Uniform Load A R1 =9410 R2=9410 SPAN=25.5 FT Uniform and partial uniform loads are Ibs per lineal ft. BeamChek automatically added the beam self-weight into the calculations. s TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel / Permit# 3/ Q Health Division f 2 `/S�f�J Date Issued Conservation Division Fee Tax Collector Treasurer _.�C11 p,� �� 4�(�([.l Jz-/i3/Cl SEPTIC SYSTEM MIDST BE ti Planning Dept. INSTALLED IN COMPLIANCE WITH TITLE 5 Date Definitive Plan Approved by Planning Board ENVIRONMENTAL CODE AND Historic-OKH Preservation/Hyannis TOWN REGULATIONS Project Street Address Village /"l /Z57'ox-1 S /'-t;lCa / Owner i t� j�,�SLi Address T`? 7 , A•0A-e_ Telephone Permit Requests ,4 Square feet: 1st floor: existing proposed DD 2nd floor:existing ®D proposed Q Total new �D Estimated Project Cost D oz�0 Zoning District Flood Plain Groundwater Overlay Construction Type L1>o®4 2 iPE ,s Lot Size�a=a 3 Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units) Age of Existing Structure '2 1 Historic House: ❑Yes Z No On Old King's Highway: ❑Yes ;KNo Basement Type: XFull ❑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_ Z new Total Room Count(not including baths): existing new First Floor Room Count 3 Heat Type and Fuel: >Gas ❑Oil ❑ Electric ❑Other Central Air: ❑Yes *o Fireplaces: Existing New Existing wood/coal stove: ❑Yes �06 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 O Yes ❑No If yes, site plan review# Current Use 1� Proposed Use S/AA`e- ,r�pftt l X BUILDER INFORMATION Name?o b PWT Do/�i�lcr Sow Telephone Number ��-/�O - L/3 e� i Address VX>e License# S4 Home Improvement Contractor# /O Worker's Compensation# &Nua ? ;-?!- c12Z 5-7M ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO o SIGNATURE DATE _% g FOR OFFICIAL USE ONLY PERMIT NO. 4 e) 1. aq DATE ISSUED ' a MAP/PARCEL NO. ADDRESS , VILLAGE to OWNER ` I DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL :GAS: ROUGH FINAL FINAL BUILDING S a• , r DATE CLOSED OUT a• r; ASSOCIATIONTLAN NO 6� The Commonwealth of Massachusetts Department of Industrial Accidents 0ftyce 811firu ffox oos 600 Washington Street Boston,Mass. 02111 _ Workers' CoIn ensation Insurance Affidavit location city Qhone ❑ I am a homeowner performing all work myself. ❑ I am a sole LIJLOIJL et or and have no one worlds in any ca achy /%//%%%/�%1l-0/%%%0,"'o, %/1,1!E F////7/////O%//%/O////l%%//%/////%/////%///%/%/%//////%%O//%%/%��%/ an em lover roviding workers' compensation for my employees working,on this job.:: : :::.:<:::>«::<::«::;:::: �j I am P P........................:....:.:::.. ..:::............ • COD1Q anv nam "'{'•< padre :>. c > > "hon Cl , #t} .... ........... . of / S� \ ... insurance co. ❑ I am a sole proprietor,general contractor,or homeowner(circle one)and have hired the contractors listed below who have thefollowing workers' compensation polices: fo ::...................................................................................................................::: ::,....:.,::::.:::::. g ......:.:::::::::::::.::........................:...::::. ::. ::::. ..... ....::::::::.::............::::.:::.:::::::::.................:....................:..::::::.::::::::::..:...........:.:.:::::::::::::.::::.:::::::: com a Tinifie.same s ...........:..::.:::.::..................... :.:::::.::::;.:;:.::;.;;;:>:.;;::.::.;:.::.......:::.;:.::.;:.;;::;::>:::::::>::::;::;:;;:;: ;:•: :::::::::::::.................................... e - :::D tv ;..,:t.::...; a.. ....................... .................................... ......... ...... ..........:... ...................... ................................................................... ........................................... .....•:.:...-.wtw..... ..: :4i:<i.;:.::....:::::::::?<'.�.:�::•:.�::::::i>.•ii:Jii:4::•.�:::w:::v::::::::::i:..........: ^:try}:.�::::•::::::::v.:ii:t�ii:•i::::::::::.�.i:iv:•:i::^:::. ./I::;:.:i:i:.ii:.:<..�.�::::.:.::.�::::•::.:.........: :.. insurance:cQ : :.::<.;:. ...>.: <:<.;:::;:.;:::.:t.:;.;;;;:;.:.;:.:;:.;:.>;:.;;::.::.::::..::.::.;:.,<::. ::: ::. FM dtv� ................. .....::. lieu ryry� 0 �•��•Y������� � i�:i.:�{�.:::::;::::�:.:;�: +.~:.'�� i?::: im"fife is Failure to seems coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to 51,500.00 sailor one years'imprisonment as wen as civil penalties in the form of a STOP WORK ORDER and a fine of$100.00 a_day against me. 1 understand that a copy of this statement may be forwarded to the Once of Investigations of the DIA for coverage verification. I do hereby certify under the p and penalties of perjury that the information provided above is trru and correct Signature Date ( f Print name �o(, o•Z r�Iylt�LdSo>t> Phone# y� d official use only do not write in this area to be completed by city or town official city or town: j permit/Ilcense NECO03: ding Department nsing Board ❑check if immediate response is required ctmen's Office lth Department contact person: phone#; u oemed 9/95 PIA) - • Tabla.tt2.ib(tamed) Presaipdre p2c"m for das and Two■Famsk Rnfdem W Bnildln Heated with Fond Fade MAXIMUM lYl�ldllUlll Wall Float' 8alemmt Slab Nellin8+Cocan6 d Arm'(%) Uwoimt R4%i R-vab l- &Valved Wall M=tw p � Rrvaheat &vaned 18 5J01 to 600 Headms Det eve Dam Q 12% 140 1 3E 13 19 1 10 6 Na:mai 1. 12% 032 30 19 19 10 6 Nommi S 12'0A 050 39 1 13 19 1 10 6 t3 AFUE T 15% 036 3s 13 23 WA WA NomW u 15% OA6 3a 19 19 10 6 Nmmd y 127i IRi4 2e t+ ��„�, WA Itii ttS AFUE W 13% OJZ 30 19 19 10 • 6 1S AFUE x ism. 03Z 31 13 2S WA WA Normal Y law/. OA2 31 19 2S WA WA N� t ta•/. 0.42 31i 13 19 10 6 90�� AA tam/. O10 30 19 19 t0 6 90 AFUE 1. ADDRESS OF PROPERTY. ( D��� G� 2. SQUARE FOOTAGE OF ALL.E CTERIOR WALLS: 3. SQUARE FOOTAGE OF ALL GLAZING: I o� 4. %GLAZING AREA(#3 DIVIDED BY#2): L19 20 S. SELECT PACKAGE(Q—AA-see chart above): s NOTE: OTHER MORE INVOLVED METHODS OF DETERMINING ENERGY REQUIREMENTS ARE AVAILABLE. ASK US FOR THIS INFORMATION. BUILDING INSPECTOR APPROVAL: YES: NO: q.fonns4980303a °FME 1 I�°� The Town of Barnstable : IAMSTABLL 9q,A ' �0�' Department of Health Safety and Environmental Services a rEo 39: °i Building Division 367 Main Street,Hyannis MA 02601 Office: 508-862-4038 Ralph Crossen Fax: 50&790-6230 Building Commissioner Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion,- improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. (? Q Type of Work: ,&e=ka6 dogUi e Estimated Cost Address of Work: Owner's Name: �C Date of Application: l I hereby certify that: Registration is not required for the following reason(s): ❑Work excluded by law []Job Under$1,000 ❑Building not owner-occupied ❑Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: Date/ Contractor Name Registration No. OR Date Owner's Name q:forms:Affidav ESTIMATED PROJECT COST WORKSHEET Value LIVING SPACE g6e�0' square feet X $55/sq. foot;= GARAGE (UNFINISHED) square feet X $25/sq. foot= PORCH square feet X $20/sq. foot= DECK square feet X $15/sq. foot= OTHER square feet X $?Wsq. foot= Total Estimated Project Cost L� a J g990915b BOARD OF BUILDM REGULATIONS±;, license: CONSTRUCTION SUPERVISOR �. NumberI,,CS. 045357 a Blrthd96iiljjb_1_•1947. Tr.no: 6733 is ad;To: 1G ROBERT C DONALDSON-; 3 AVIATORS LN' SANDWICH; MA 02563 Administrator '. i S'�4�t' �$: j. �/.w�'�jt-�1 r'�, •'Y'car?f� x -0;_tfr.L. 1 OMB NPROVENEMCONTRACTGR 0 L 50N N TRlUC+ I.M. ~ oDki ADMl R 3�iRUfA URSrLANE SA YICkI MA 025.63 � �.�. , �`. .;,;,„gip, ..,�,;,,.�:•. . G O r ' r s\r,- r. `` sFP Tic P�4 "'�y�. _ `� r I -. �..•7z�•�= ,. r(1 ref � 1 r g3 " s'6 o jx" ui y,s� tr? P tit, e•:ti 1 L 07 � i t• ' qx ti�u �° >Y�4C-K � nca<<' L R LEGEND EXISTING SPOT ELEVAI "� \ XISTING CONTOUR --= _-11J1INISHED SPOT ELEVAT SHED CONTOUR ?PROVED BOARD OF DATE AGENT -L DREDGE ENG/NEERIH rii-EG `REGI! CIVIL LJ ENGINEERS SURI C' t:A; S T 71,12 i front existing new 18' 0. side new existing 22' SMOKE DETECTORS O.K. 20'6" BA RNSTABLE tJILDING DEP reari, existing I new living room r I ^ 22' UO 3-2 1S2 V existing 1 st floor plan i J 18' 1 ]0 I� o 8'S o 22' new bedroom & bath e existing O � H 4'4 2nd floor plan sse7r PlAes aN T*%,t /'� � e�.�-` 'lam ✓L .q,.....�c•..�y� R 3 o r�►i�l Arlo,u aXB" G' llk� rolaT DEC A e"7Yi►l 117�8` A)l T6 s r R t°1 ►HS Tj*V • 2x(�" ccT• sT� 7li� Gbx sL,oL 3/g` TAG s��'Gloo� r/oor'Tou T 3 2"X10" girt '31/2" cone filled lalley 6'0.C. 8" c.ka�,tTe wAl/ • - 3 " Kok �►�r� F/��. aa ' ���Ti6A f - 3. � o o 0 0 s T2 162 001 o p�e w�afac►cc)— r-��.�r Ff�M�2'S PdtLGH w".# P,&ce- t-mC4 rvtL 22' 0 ��o-•-c�ftrrrct G� : I El 0 ss o a Li•71 o 18'3 a . ; AN �,J to►uaoz JS 54q u6WT(?) rd rL r 2 Mi O O U Aj O r) te m m z V o_ lap /�f� wow c� gers� z O _ I ax co z 0 U 7_ n 0 J Q z O O E O w LL. ss. 's map and lot number ..x.a. 1".. ... :. ..�� ���' p�C 7 2 y� 77 Sewage Permit number ...............................................:.......... °FT"Er° TOWN - OF BARNSTABLE B,HHSTLBLE. i b 9- �0� BUILDING INSPECTOR 0 YPY a' APPLICATION FOR PERMIT TO TYPE OF CONSTRUCTION ............................................... .............. ... . .......................197�. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: ' Location ... . . . .............Z-...}....... .�..�.0�.....c..c..T..n...v..�....1..�.�..1.;/.;/..S................................,........................................................ -�- J Proposed Use .. S lcs1 Cv� t 1.a.�.... r t: .l. ... c...... 1'/................................................................................................ ZoningDistrict ................... ............ ......... .............................Fire District ..............................................................A................ Name of Owner—no of �.. 0I c.............................Address :t a Name of Builder �a..:1wc.........................................Address S F �1 Name of Architect 79�X.A!�?r ..� ...........�-...�.�...................... ..Address ................ Number of Rooms ... r TC- ..........................................................Foundation ...... /i.r. o.... ............................................... Exterior ...TlC.:; ...........................................................Roofing .45 .4:!J _ 6 k5s Floors 1i.4 c C,• �.w l$vU r cr/,.yr�•�-r......Interior // �//,i ,�/v --}- ............................. Heating �.:.t c ¢ �` / �" ......... 9...................... .....................Plu"mbingir,h Fireplace ..... !:.! .:r.P..` /,,, . !�......................................Approximate Cost .........................................I...... , . Definitive Plan Approved by Planning Board -----------_------_-----------19_______. Area ...........�Diagram of Lot and Building with Dimensions Fee ................................. SUBJECT TO APPROVAL OF BOARD OF HEALTH ' I I hereby agree to conform to all the Rules and Regulations of the Town'of Barnstable regarding the above i construction. Name ... � //.L�s !I,/ .c.f; /..:... i �Pw� w~ Inovativa 8u1ldarai A=47~131 . ` . . � 19519 ` two story ............... Permit for ------.-----.. � single family dwelling ----.--.----.--.—_--.--.----.. . [ Trotters Lane /� - Location —..~".'�_--_--___________ Marmtooa $M1lla � ^~--`--~-----''--~---`---`---' Inpvat1vm Boild�ro ' ~ Owner ---.-------------__.__— . frame . Type of Cunutruction. -------------- ` Plot ............................ lot ................................ ` ` � A� � Permit_ Granted_ -----. � --- of Inspection_ --- � � ' - ^ ' ' .. . /PEIRMIT RE.FUSED 19 ° � ....................................... ----. `� /^�» �6 � � ----. ' o ........................ � ..��...— ............................... . � —.----' � App,ove6 --..�---_-------- 19 . . ........................................................... -------------''.--------'--~^'` � ! ttj i t I l\; 't _ / 1 14 ' s,F �v f � 7 4 3 ,3 CIO - M M G ROOERT P. �q SUMIKIS Ne.(u20 ti O ST`'� CERTIFIED PLOT PLAN NEW 'CONSTRUCTION ONLY -- - - - ---- - ---- -- --- - TOP OF FOUNDATION -IS -a FEET IN ABOVE LOW POINT OF ADJACENT. .0A111AS-1A.91aAiNASS ,ROAD. SCALE- / "Y 40 DATE : 7/, �ELORED�E ENGINEER%NG CO. INC. CLIENT _D!o!� I CERTIFY THAT THE E(31STEED rRE01STERED — SHOWN ON THIS PLAN IS LOCATED R CIVIL I i LAND JOB NO. _� ON THE GROUND AS INDICATED AND n CONFORMS TO THE ZONING LAWS `ENGINEE ',SURVEYOR OR. BY: OF BARNST Lf;� , A SZeoo�� CH. BY: • T' %a • 33 N0: MAIN ST '12 .MAIN ST. S0. YARMOUTH, MASS. HYANNIS, MASS. - - - -:----- SHEET�__Of � " DATE KEG: LAND SURVEYOR ' ok I r No !! y� i � `_lam_ ••-__'"_��--�'! ion l r� 20�2�' s.F. 1 A gs --- !' fl s 4 7,'4 1 — 1' 3 1 Of ROBERT P. s. sUNIK18 ` No.0420 • q p , Oa , CERTIFIED PLOT PLAN NEW CONSTRUCTION_ ONLY : - — TOP OF FOUNDATION IS __�?- FEET IN ABOVE LOW POINT OF ADJACENT 9A aA S'1A.9la xlj SASS. ROAD. SCALE : / � 4U DATE k11717 7r ELDREDGE ENGINEERING CO. IN�C D/p/V I CERTIFY THAT THE ' - - - -� - — ---; CLIENT — SHOWN ON THIS PLAN IS LOCATED EGISTER D l (REGISTERED ; _ CIVIL I I LAND JOB N0. 77° `>t8 ON THE GROUND AS INDICATED AND �NQ�NFERS. SURVEYOR DR. BY •�' �+ /I`J • CONFORMS TO THE ZONING LAWS Z_.:. -- -- ---- �, . ?' /� . OF BARNST L,� , M,A S. 33 .NO. MAIN ST 712 MAIN ST. C: � , _ __ �,�•G /�� � / SO. YARMOUTH, MASS. HYANNIS, MASS. SHEET / OF I O DT. REG. LAND sum ►Q-7OR ssessor's map and lot number .. �.. ..:. ..L ���' �c 2 y� 7 SEPTIC SYSTEM MUST Bt . INSTALL J (; ,,� Sewage Permit number .................s............. ......................... WIl °i Fa:Y N �;R E CCYI^tiPLla e �.d SA�lIT STATE ARY CODE AND TOWN yO�TNETO�` TOWN OF BARMST'A-LE BUILDING 4 INSPECTOR APPLICATION FOR,PERMIT:-,TO .....&.1.14.....N.C-w C'aKS 1 ry �a`� .... TYPE OF CONSTRUCTION ....... .....G..................... .................................................................................... 7.-..z ................................97. . TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ... r9 .� .... r6:(/. r5`H....... "/. �S�dyl...1. .l�/ ....................................................................................... Proposed Use .. \. . .�1 t.4..1....�.lIh:;....-.f kN.'1']�............................................................................................... ZoningDistrict ........................................................................Fire District ............................................................................... Name of Owner N..�1ll.� ...��...��W44� .fS....................Address ...S-gge.vLlsT..1/1.1.LGS� 1. !5. ... Name of Builder ........s.s'w. ..a,.......................................Address 3lur.M..15 ............................................................ i / Name of Architect -TdImT. t.c,c,yl..................................Address �G�Q.. GG1H.S ��:5. oJrt. ..YJacl e(�. ,..... Number of Rooms ....6..........................................................Foundation ...�Q.11�.�`o�...C.ayl.f�.rr, F Exterior ...1G. ...Roofing Floors l/j S �..Lr� l9Ul.�-1d- `,�'j''�r Interior ...... ,Y ., .. �! ...... .............. flf'/ .1t1C�4-.� ........................................... .. . Heating ...C4.fnak�., .................Plumbing ......4 C:.r........................................................ Fireplace ......................................Approximate Cost ..., (.f.�.. .v.................................... ...... Definitive Plan Approved by Planning Board ---------------_-__.: ------f 9--------. Area �-� -__ Diagram of Lot and Building with Dimensions Fee P��-� 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 f. constructi.on. Name ... i!/l/.1.. � ....Q -�./.�clf.l✓Lrry. � Inovative Builders ~ qkq two story � .............. Permit for .................................... �Vngle family dwelling � '—'--------'—^---'-''~^---'---'—^' Trotters Lane ' Location -----.--.^----_-------.. 0�~~. �=^=t000 Mills ' —,—.—.-----.----------.----.. In»vativa Builders Owner ------------------___— . ` frame � Type of Conutruction. .......................................... ' ^+ . .—~—.. .—~—..---.--------_--- #18 Pkot .—..--.---.. Lot ----------.. ' PmPermitGranted ^ ............... 77� ` . Dote of Inspection! ---l9 ' ' Date Completed ....... � � � � PERMIT REFUSED - --.—..---.-.—.._---------. 19 � � ....~^......'......���'''``�'`�'^^��'�'����^� ' � ^ � ' ) � .—~--.---------.--.—..--------. . .^.~-...-..-,—..-----._.-.—.—...—..—.... .—.---...—..—........^.,.~.-...~—...—' ---------------.. 19 � .------------..--....,—...----- ' ................ ` ' | / _ �