Loading...
HomeMy WebLinkAbout0387 TURTLEBACK ROAD o . _ �- TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION. Map Parcel; QS's t: - Application # �G1 Health.Division s Date Issued Z Conservation Division �✓ Application Fee Planning Dept. r' Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH Preservation / Hyannis- Project Street Address Village Owner U.x Address /'inr2AFV41e 4,czi4n Telephone - ,SUfi- Permit Request ,. %Z�.�i1�6�/�fJ/�f� . 1G�i0 i.�k/Srib� �1�/LfU✓�i..� Square feet: 1.st floor: existing ,proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl 44 Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing Z new Z. Half: existing new Number of Bedrooms: existing —new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas Il Oil ❑ Electric ' ❑ Other + Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stoves❑Yes IN o Detached garage: ❑existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑existing 6'new_-size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Z Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial' ❑Yes ❑ No If yes, site plan review# a ;, Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name efl /✓ /US,�OG/e0%// ����G., Telephone Number ,SU�-�6Z-- �'77 Address /96 60-- License# /644-442,r43 Lis 1W, 0V JD Home Improvement Contractor# /DU//0 Worker's Compensation # ZOO ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE ! l_, , DATE Z- a -0 8 It' i, i> '? FOR OFFICIAL USE ONLY r APPLICATION# I'l DATE ISSUED MAP/PARCEL NO. 'i ADDRESS VILLAGE OWNER DATE OF INSPECTION: ► FOUNDATION =FRAME INSULATION oK �ef :J +� FIREPLACE ELECTRICAL: ROUGH FINAL ` PLUMBING: ROUGH FINAL -`GAS: ROUGH FINAL i FINAL BUILDING kk DATE CLOSED OUT It. ASSOCIATION PLAN NO. - ; The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): - Address: City/State/Zip: /V• S/�/9�(z I'M Phone.#: J.,Pb- 2 �,/»D 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 employees(full and/or part-.time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g. ❑ Demolition workingfor me in an capacity. employees and have workers' Y P tY• $ 9. ❑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' 13.❑ Other comp.insurance required.] *Any applicant that checks box#1 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 the policy and job site information. Insurance Company Name: 66, Policy#or Self-ins.Lic.M 4/6 GSf(/D S�'6"00/ZGG-' 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 WA for insurance coverage verification. I do hereby certify u der the pains and penalties of perjury that the information provided above is true and correct Si ature: Date: Phone#: 2 ' y . 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.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 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 representative's 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, §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 fo any business or commercial venture (i.e. a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like 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 406 or 1-977-MASSAFE Fax# 617-727-7749 Revised 11-22-06 www.mass.gov/dia I Client#:43203 CAPEASS • ACORD. CERTIFICATE OF LIABILITY INSURANCE 0DATE 8/31/8/31/M/DD/YYYIr) 07 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Rogers&Gray Ins.-So.Dennis ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 434 Route 134 HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR P.O. Box 1601 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. South Dennis, MA 02660-1601 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: National Grange Mutual Ins.C.O. Cape Associates, Inc.P.O.Box 1858 INSURER B: Associated Employers Insurance Co. North Eastham, MA 02651 INSURER C: INSURER D: INSURER E. COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT.WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR DD POLICY EFFECTIVE POLICY EXPIRATION LTR NSR TYPE OF INSURANCE POLICY NUMBER DATE MMIDD/Y DATE MM/DD LIMITS A GENERAL LIABILITY MSO41163 01/01/07 01/01/08 EACH OCCURRENCE $1 OOOOOO X COMMERCIAL GENERAL LIABILITY DAAMIAGE TO RENTEDPRE ISES(Ea n $50 OOO CLAIMS MADE DOCCUR MED EXP(Any one person) $5 000 X PD Ded:250 PERSONAL&ADV INJURY $1 000 000 GENERAL AGGREGATE s2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG s2,000,000 17 POLICY PRO- LOC JECT A AUTOMOBILE LIABILITY M9041163 01/01/07 01/01/08 COMBINED SINGLE LIMIT ANY AUTO (Ea accident). $1,000,000 ALL OWNED AUTOS BODILY INJURY $ X SCHEDULED AUTOS (Per person) X HIRED AUTOS BODILY INJURY $ X NON-OWNED AUTOS (Per accident) X Drive Other Car PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ` ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG S A EXCESS/UMBRELLA LIABILITY CU041163 01/01/07 01/01/08 EACH OCCURRENCE s2,000,000 X OCCUR CLAIMS MADE AGGREGATE s2,000,000 DEDUCTIBLE $ X RETENTION $10000 $ B WORKERS COMPENSATION AND WCC500555012007 08/24/07 08/24/08 X WORM TU- OTH- EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $500 000 OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $500,000 If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $500 OOO S OTHER DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS "Workers Comp Information*' Workers'Comp and Employer's Liability Included Officers or Proprietors (See Attached Descriptions) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Town of Barnstable DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL _10 DAYS WRITTEN 200 Main Street NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL Hyannis, MA 02601 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE 2. ACORD 25(2001/08)1 of 3 #S30677/M30676 h DD © ACORD CORPORATION 1988 F: ,i, -...a•�_\_= a..�7''�i ���d/r�%r2i�d��.�%���i4�i e C�' � 2-...:• /6w.ja dw Board of Building Regula ions and. Standards lace Room. 1301 One. A.sl.�.burton.P Boston. Massachusetts.021.08 l:lome Improvement Contractor Reg;istrataon Registration: 100110 Type: Private Corporation . Expiration: 6/9/2008 . ' CAPE ASSOCIATES, INC. MICHAEL COLE . PO Box 1858 N. Eastiiam, MA 02651 Update Address and return card. Mark reason..for change. i? Address I_l 12ene��al ❑ Employment Lost Card UPS GAi ci WIvbQ4i05 P 8f98 ` it<i:��.: � � ;:,��!? f%gyp J![:U2lr•/zf/.�r:2��� C! ..a'C.!Zd:l flGll.flJ��b � .. .. `\ Bard of Building Regulations and Standards License or registration valid for in(tividut use onl)• i it r� Ii" HOME IMPROVEMENT CONTRACTOR _ before llie expiration date. 'Lf found return.to: Board of Building Regulations and.Standards Registrat.ion:. 100110 One Ashburton Place Rut 1.301 , Expiration:..6/9/2008 Boston, IN-la.02108 Type: Private Corporation CAPE ASSOCIATES,INC. MICHAEL COLE 345 Massasoit Rd (..'i Not Valid N�'ithout signature ; N. Eastham, MA 02651 Depute Administrator r t 6,`Sdu',L�.'IAN':lEiJAir:a:�ir.......:1.....::+lr..r'.::.�.,v.rt.:•aN.wr...t..x .v...v.vee\M:aulaK.J�:�.�.�un,_ti:-e.v:.:n:,wlnt�:.a r. �.nnr..r:.:. i u..,t.'.ml,I'..,il'„u„�.:.. . r...l.,i:ei,:•lN ,..if.H.1..,f..av,G.wk:1CPSEl'lt..Ob:at%Inb-n U.,dAi-�,1.�" u.(A',...1.1.i�C..,-t'a4n.S,aSnfL.�.la..Yd•J,ii.ni.. .. ...- ...... v.fh1 i (46 SegUiatdn✓9vtalJrd l s B Construction Supervisor License LEce�ise: CS 14985 , Tr# 15123 i�4121/2010 MICHAEL H COEFN '_: �< PO BOX 1858 N EASTHAM, MA 02 Commissioner TOTAL P.01 ' J oF1HE, Town of Barnstable Regulatory Services • BARNSTABLE• v MAW. �, Thomas F.Geiler,Director lF039. & Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I, Allf2,SD-A0 /sVfW , as Owner of the subject property hereby authorize CAI: _s to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of Job) /Iz� z , G Signature of Owner Date Print Name If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. Q:FORMS:OWNERPERMISSION Town of Barnstable �pF IME Tp�� Regulatory Services + BARNSfABLE, % Thomas F.Geiler,Director 9 MASS. �A 019. ,0 Building Division jEo �a Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-7907-6230 --------------------------------- HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": 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,requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-fanuly 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. i Q:forms:homeexempt <y 1 _ �X11�+p,`l [�r`.�_, i1��Y.(.v '�•i+�\�r `I hir111!I \ t� I� �i ;ems n f ? I l 1 ; e ��n } u i �y ' I �' � Ali �'�� t•�y a. KI Lj- To � s. r1 ` ,,;4� +r �1,4 r r,, + ici e t ' 1 t yn} k +T 4 I � ,.,,�..- � ,,. ..- • .. ., f - �., �j � ,. ,��, ,4J,W ���sss ASP t •'L'- i � ;.y r. � ����✓j�lJ CJ iV Y.�iV I�Iff{Iy.' \1 r I �."" 1q3 � rE� �. �II r,,•tY, .-•sv-�= (( -�c� �i ' �, •y,. yy�+��I',f� ' \ f ,J .�/1 (�1.s I,/tl i - !' .. , 4 � 1•- �"�'*•�] t �w tl; ~�_' ,7 }, -... ...... --'- '".�~.:.'�t..a;.ier3:rli.ir�.+�►. s �'tl� •r� '.e����snl�?��1 ' 1 ! ..-,,,,� t ',�s�4�!'1�'f��� �r.F f �, ' }i',L{{', M`.. r `d,• �4t•'r p����!' �r. ��•, ��:��•(. \ / e J'�r_.w..w, � � �. ...., ,r-.•J _�•"'_A 1 [ � t ai �� VVV 0 �f �wy��/r��C�'yr ` ,.. CM�� '- 1 J � .• .:y � ��t � ���\. }a .1� pi•'!4•K .'.YG 1 .y 4 r `+.� a r�, �:�:1 I �•� ..i \ { i' 1.,F i f .A' r ri � '' ii \' .! w.�� ,'�,t� _.� n•-_.•�" I 1 � 4. �.+ , •+!� tt v, •'� it � /y `) VA NOW, INN • �'"1. `r r ,lr .'r.>�11t+ � jI S�' ' ~~ {/II`t� ll� �jV�N�{� {�VI.JV V• .r. ; »-•.— .._., �.-_- �_ _� i`! H 1 ��.1-r— » •�- »..r , ; y,..,I!++�-= y, t- i iJ rat s.!^� J 1 i F!r '"¢,�. } {'�,�'!R Yoe. , .` - 1 r .. �t 7'. ♦ ..,� �_ . ;r�.rL ':.� ;��--(XQ;�7p O��r� ';J'} •y- �J �..'.�i�'.�.Iti.:��:;��Jt.�.:�� I1�• I�'��'�75 Kam`!"j �_ . '. ,� s: . ,tt.. ..., 7 1, ,.rt�� �_._,4..._...�:�ii���t�� �1�.��7:'J �3`�U•�.?"1�!•�s�..._ .. �_. .i ,� .�_... _ ...�I;._. � ._ - _ ' . ._ _....,..,._. __ ._.._.._ r��c� t � ,.,Z 7-c S I A�f . jf{ >w 5� IA yY � �I ;a �7 < TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel Application# 6z 6e�a Health Division Date Issued g Conservation Division Application Fee OD Tax Collector Permit Fee �o Treasurer Planning-Dept. Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis - Project Street Address 387 f fJX ZZA6i9c lk AO/910 Village 1Z191ZS%10%0S :�I/L" Owner 11111GS-eiJ `� ��'/yL� �/L/�GJ Address 761.7 Telephone ,51,G16.. 5/2 S9S'9 Permit Request 6o.c,T/l.1C.T Alilw •17��,� �"�S"T r"S ��o � ;�Lte./S' �•�c�y�� Square feet: 1 st floor:existing proposed 2nd floor:existing proposed Total new Zoning District X/s Flood Plain Groundwater Overlay c Project Valuation E Z 0 Construction Type E✓c�c�!, Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family4d Two Family ❑ Multi-Family(#units) - Age of Existing Structure /�7_'3 Historic House: ❑Yes ❑No On Old King's Highway: ❑Yes O.No Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) v Number of Baths: Full:existing new Half:existing new M Number of Bedrooms: existing new rv, G G Total Room Count(not including baths):existing new First Floor Room ount Heat Type and Fuel: ❑Gas ❑Oil ❑Electric ❑Other E ', Central Air: ❑Yes ❑No Fireplaces: Existing New Existing wood/c a stove: .13Yes ❑No Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑ex sting ❑-nbw stze � Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ c� Commercial ❑Yes ❑No If yes, site plan review# Current Use -Proposed Use BUILDER INFORMATION Name lLJr�' �JSS(JG/�fI/'lS�� �.C�L� Telephone Number %>70 Address ./'Lc-0 ox License# 0/</ • �� %�J3 !/� /�I/1.. (�7�6 l� Home Improvement Contractor# 0 J Worker's Compensation# ZOO T ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO TC�w�,� !s�`s' UU✓Lh/ SIGNATURE �_.c-z/�--� �:�.� DATE Z•6<- 0 19 r" i fir. ry FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. ADDRESSi VILLAGE F OWNER 'DATE OF INSPECTION: FOUNDATION SGJ1rOS bb !2{�► FRAME - 4o INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING nor- /000 r DATE CLOSED,OUT' ASSOCIATION PLAN NO. - , J Town of Barnstable Regulatory Services $"R'''AS& Thomas F. Geiler,Director Building Division Thomas Perry, CBO,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 PLAN REVIEW Owner: Map/Parcel: 0�9 Project Address 387 T/ltce��cK Builder: 1gp25- �ssc�i.s�zEs The following items were noted on reviewing: let. N1� (� AKel (92 qd E 'F/4' TC—W T /T Q u/"itL f-- ST/Z Ix NUKE C ✓ S-,u O CJ Go*6 O'((��{ !C, PoSI"/Cft if-OW-GNM l=N T NL c4,S-r N,2 p U r ��s7- cx ,pn P s r � S060-rk,BE� d0,V AlZ-t:-rIo/� 7-0 € ic!5/° b aa2E `T-k-- 0.,0 &3C.i2 E r= . Reviewed by: Date: ��� P A Q:Ponns:Plnrvw ' The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations e 600 Washington Street Boston,MA 02111' wlOw.mass.gov/dia ' Workers`Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers _Applicant Information .Please Print LedblY Naive(Business/Organizationadividual): Address: /'1;."0 joy::: City/State/Zip: W.,�4rnrll*'t-7 /`ZOO. OZe V Phone.#: SCJ� :s't'� 2 77® Are you an employer? Check the appropriate bog: :Type of project(required):. 1. I am a employer with 4. ❑ I am a general contractor and I • have hired the sub-contractors 6. ❑New construction . employees(frill and/or part-time).*2.❑ I am a'sole proprietorRemodeling or partner- listed on the-attached sheet. 7• ❑ ling ship and have no employees These sub-contractors have g, Demolition 'ovorlan for in an ca aCi employees and have workers' g Y p t3' t• 9. Building addition [No workers' comp•insurance comp.insurance. 10.0$lectrical repairs or additions q required.] 5. ❑ We are a corporation and its 3.❑ I a homeowner doing ill-work . officers have exercised their 11-❑Plumbing repairs or additions ' myself.[No workers' comp. right bf exemption per MGL 12.❑Roof repairs insurance required.]t c. 152, §1(4),and we have no 13.❑Other employees..[No* workers comp,insurance required] *Any ipplicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. f Homeowners,who submit this affidavit indicating they are doing all work and then hire outside contractors must submit anew affidavit indicating'such. tContcactors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether ornot those entities have employees. If the sub-contractors have employees,they must providt:their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is.the policy and job site, information. Insurance Company Name: �. �L�C//Jf� %f��l�GrJy/ �✓�� G�} — Policy#or Self-ins.Lic.#: hc;C, L�ce��SS U/ ZCo-7 Expiration Date: Job Site Address: ��7 Tl/���- �'�l e��' 1?64-1) City/State/Zip: /jy✓�.aC�S '�/��, � . 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 maybe forwarded to the.Office of Investigations of the bIA for insurance coverage verification. I do hereby certify,under the pains and penalties of perjury that the information provided above is true and correct" Si►mature �%�-✓L—• ��`�-_ Date• Phone 4: g��/ Z i'77U Official use only. Do not write to 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.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: r� 0 Board of Building Regula ions and Standards Oniz. Ashburton Place •- R-oani 1.301 Boston, Massachusetts.021.08 p . Home Improvement Contractor Registration Registration: 100110 Type: Private Corporation < Expiration: 6/9/2008 CAPE ASSOCIATES, INC. MICHAEL COLE . PO Box 1858 N. Eastham, MA 02651 Update Address and refur•n card. klark reason for change. '? Address i:1 Renewal ❑ Lmployment �� Lost Card Ur`''-CA7 '`a 50ht-Oa0°.PC8698 '\ Board of Iluilding Regulations and Standards Licensc or registration valid for individul use only il,t: rt�r HOME IMPROVEMENT CONTRACTOR before the expiration.date, if found return to; Board of Building Regulations and.Standards Registration: 100110 Place One Ashburton 1 Ltce Rui 1301 °- Expiration: 6/9/2008 • _ p Boston,i\7a.01105 i Type: Private Corporation CAPE ASSOCIATES, INC. MICHAEL COLL= 345 Massasoit Rd .._ _.._,.�=`--._.`'---:•...--- C�,,.--�= ,, Not Valid without signature N. Eastham, MA 02651 Deputy Administrator „ t it i + Jr1C.�:v'illi>' ;(L'aJbi'n.i..,a.h:[,:J,u.�i:.v...:..abv,.<:::_�uw.-,. v;.•r c:...,�.::r.:....wro i.a..,,,..r,ai. ... .. .-..wit ,. , ..e..a ..._ :d.... ,.:ihuw.., ...,.1.1,4_... a. L..-ttL,wt._J_iO�„JI_.{lk..._.1JJ 1,..rJr......rlm p...u..Inx..,.+m„p., u. ... .-,..., .,_,t a. :.+ rn���t 4F�5' /// OL �i iGGCL00CZC%J�%Gl6P.C� ... rrejt��? ✓7�.Pi O�iI BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR ff � t'x Number:. C.S 014985 Birth 1947 Expires 02/21x/2008 Tr. no: 15816 17,1 a° • = Restncted 00' 1.} L t : .= MICHAEL H COLE PO BOX 1858 �� ,y f G- f N EASTHAM, MA 0265�1 Commissioner . I ` Town of Barnstable Regulatory Services BAMSTARMAS&M Thomas F.Geiler,Director �'��D;�r►`� Building Division Tom Perry, Building Commissioner . 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-8624038 Fax: 508-790-6230 Property Owner Must. Complete and Sign This Section If Using A Builder I, 0%�So eV �2h/ , as Owner of the subject property hereby authorize C A G 5S°Q A 7 C S to act on my behalf, in all matters relative to work authorized by this building permit application for 3 9 -7 %ilk-T[ZRAck- e-D M,Ps7o NS ,a'/44,s M4 O Z O-f g (Address of Job) Signature of Owner Date Print Name Q:FORM&O WNERPERMISSION i 10'd Iti101 Client#:43203 CAPEASS AT ACORD,. CERTIFICATE OF LIABILITY INSURANCE 0813107 DnYYY) PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Rogers&Gray Ins.-So.Dennis ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 434 Route 134 ALTER THE COVERAGE AFFORDED 9Y THE POLICIES BELOW. P.O.Box 1601 South Dennis,MA 02660-1601 INSURERS AFFORDING COVERAGE NAIC 0 INSURED INSURER A; National Grange Mutual Ins.Co. Cape Associates,Inc. INSURER a: Associated Employers Insurance Co. P.O.BOX 1858 INSURERC; North Eastham,MA 02651 INSURER a. INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY RCQUIREMENT.TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN.THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS.EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADD' LYR NSR TYPE of INSURANCE POLICY NUMBER POLICY EEFFF E§1M PO Ct EXPIRATION IflRNT9 A GENERALLIAIMITY MSO41163 01/01W 01101108 EACH OCCURRENCE E1000000 X COMMERCIAL 13EN04AL LL48ILm DAMAGE q I RENTED $50 000 gXCLAIMS MADE M OCCUR MEO EXP(Any onr OarlOn) s5 000 PD Ded'250 PERSONAL&ACV INJURY 51 00O 000 GENERAL AGGREGATE S2,000,000 GEIS'L AGGREGATE LIMY APPLIES PER: PRODUCTS-COMPIOP AGO s2,000.000 POLICY JECOT LOC A AVTOMODILELIAEIILITY M9041163 01/01/07 01101/08 COMMN90 SINGLE LIMIT s1,000,000 (Ea weldons) ANY AUTO ALL OWNED AuTOG BODILY INJURY E X SCHEDULrOAUTOS (Per person) X MIRED AUTOS BODILY INJURY 1 X NC"WNEOAVTOS X Drive Other Car PROPERTY DAMAGE H _ (Paraodden0 GARAGE UAMLIT'Y AUTO ONLY.EA ACCDENT S ANY AUTO OTMER THAN EA ACC S AUTO ONLY: AGO E A EXCESSAIMSREWI LIABILITY CU041163 01/01/07 01/01108 EACH OCCURRENCE s2.000.000 X1 OCCUR CLAtmsmADE AGGREGATE s2.000 000 E HDEDUCTIBLE E X RETENTION 110000 s B WORKERS COMPENSATION AND WCC500555012007 OW24107 0812408 X WC STATU• OTII- EMPLOYERS'LWBILITY E.L.EACH ACCIDENT s500,000 ANY pROPRIETOAIPARTNERIEXGCIJTIVE OFFICERUMEMBEREXCLUOED7 EL.015EASE-EAEMPLOVEE f5O0 OOO If pee,deeulos under E.L.DISEASE•POLICY LIMIT $500 000 SPECIAL PROVISIONS adaw OTHER DESCRIPTION OP OPERATIONS 1 LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT 1 SPECIAL PROVISIONS "Workers Comp Inforrnation" Workers'Comp and Employer's Liability Included Officers or Proprietors (See Attached Descriptions) CERTIFICATE HOLDER CANCELLATION SHOULD ANY Of THE ABOVE DESCRI9E0 POLICIES BE CANCELLEO BEFORE THE EXPIRATION Town of Barnstable DATE THEREOF.THE ISSUING INSURER WILL ENDEAVOR TO MAIL __jjL DAYS WRITTEN 200 Main Street NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT.BUT FAILURE TO 00 50 SHALL Hyannis,MA 02601 IMP056 NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER.ITS AGENT'S OR REPRESENTATR R AUTHORIZED REPRESENTATIVE ACORD 25(2001108)1 of 3 #S306T71M30676 DD o ACORD CORPORATION 1988 TO/T0'd 2Li7T0UZ80ST S311:1130SSd 3dU3 8T:TT 800Z-90-93d 2 x/D /a' fU�sT • L/�t � ITS %Zk/D s 0Urs/a�� ON EIEF �x 6 U L. Z Z 64L 5T x »,fir! �✓�/�({/� - I � - s " . x 8 o E �GvS� v kLf� ZkZ �s>�. . 6 0>6,; Pk , 1 1 CC bj qb I , r V m - ✓� 6 70 ¢3 y 2 T .36 13). js .. 200 . N AM 771 �1o� ;ay lcilowlearle in�o tion and rna 1 certify to_f"'cawt.j �pT= # Ak'�j a result of a :survey made on- the ground �T 3G .. TU/ZTC,C�3i`{GiC.. �O• • :, .I find that: .cture(s) are located on the site as i i e lines and lines (fir nnnii,.o+� ' . X&PRESS PERMIT 'Town of Barnstable *Permit Q oG':W:?�_22 DEC' EC' 12 A Z007 Expires 6 months from issue date Regulatory Services F .TOWN OF BARNSTAEILE Thomas F.Geiler,Director Building Division Tom Perry,CBO, Building Commissioner vG 200 Main Street,Hyannis,MA 02601 i www.town.barnstable.ma.us Office: .50&862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL, ONLY Not Valid without Red X-Press Imprint Map/parcel Number 0 6, Property Address 387 1y,R-Tx l i-5Ac,�_- tNLLL-S A OZb`i� Residential Value of Work Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address N E l.'o d M. FleE i 3.V j v1 TI-E 8A&t_- f b MAR-s i o r/s MI 0 7-6 Li�3 Contractor's Name Telephone Number Home Improvement Contractor License#(if applicable) - Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor _ I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) ❑ Re-roof(stripping old shingles) All construction debris will be taken to ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side Replacement Windows. U-Value 0 3 y (maximum.44) L,/Kv StE �La-,5 dC.Q r L1. , 0,3'1 ,L/rc�, 5/;�-E *Where required: Issuance of this permit does not exempt compliance with other tovm department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. Ho rovement ntr�ors License is required. SIGNATURE: Q:Forms:expmtrg Revise071405 1 ' e UommonweaUft oj massachusetts Department of Industrial Accidents Office of Investigations ' a 600 Washington Street Boston,M4 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Pluffibers Applicant Information Please Print Legibly Name (Business/orgatuzation/individual): FkW Address: 3 8-7 v/z,1-&r- City/State/Zip: /t'V4e�siaNs MIt t�s MA awK 8 Phone #: ( S � 8� yu- 5 4S 9 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 employees(full and/or part-time).* have hued the sub-cofactors 2.❑ I am a sole proprietor or partner- listed on the attached sheet t ?• Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. 9. ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑ Electrical repairs or additions 3. I am a homed�per doh- all work right of exemption per MGL 11.❑ Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4),and we have no 12.❑ Roof repairs insurance required.] t employees. [No workers' 13.0 Other comp.insurance required.] 'Any applicant that checks box#1 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 (Contractors that check this box must attached an additional sheet showing the name of the sub-contiadtors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy andjob site information. 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 hereby certify und er the painnssfandpenalties ofperjury that the information provided above is true and correct. Sign �r �/ Date: / Z-�I Z/Z,°u 7 Phone#: (So g> y L $- S^r S g 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.Electrical Inspector 5.Plumbing Inspector 6. Other ' Contact Person: Phone In: I Information and Instructions r 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 grounds 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. 1-im*ited Liability Companies R—LC)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 like 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 406 or 1-0077-MASSAFE Fax F 617-727-7749 Revised 5-26-05 www.m2ss.>?oviaia i Town of Barnstable Regulatory Services anRr AE11 Thomas F. Geiler,Director r039.&�� Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.ba rnstable.m a.u s Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: �Z1/Z��Ao-7 JOB LOCATION: 3 $7 Tj P-rLa=BAck f-2) number street village "HoMEOWNER": M, F(?- / (S&8) W name home phone# work phone# CURRENT MAILING ADDRESS: 3 87 1 UATLEB ►Ck )D city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requrr�m Signature of Homeowner 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 O S ' �°FTME ray Town of Barnstable *Permit#i -zoPERMITz(� �- Expires G montJis from issyedafe Regulatory Services Fee p(� ,o 3639. APR 0 4 Z007 Thomas F.Geller,Director rFDMA�A ..vvi� OF BARNSTABLdRuUding Division Toni Perry, `Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 5W-862-4038 Fax: 508-790-6230 � EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY d r(^,, Not VaUd without Red X-Press Imprint Map/parcel Number OASIS Cq Property Address I*Residential Value of Work� 10 CD Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address ;onttactor's Name �—;t2 � Telephone Num er v�t2P�-q�� iome Improvement Contractor License 4(if applicable) ll� '�IQ// t�rr,, Anstruction Supervisor's License#(if applicable) 7"il..-9`T V Workman's Compensation insurance Check one: D 1 am a sole proprietor 01 am the Homeowner 1K.1 have Worker's.Compensation Insurance 1 isurance Company Name lorkman's Comp. Policy#_ opy.of Insurance Compliance Cert�icate must be on file. mmit Request(check box) Re-roof(stripping old shingles) All construction debris will be taken to� D Re-roof(not stripping. Going over existing layers of roof) ]] Re-side Replacement Windows. U-Value (maximum.44) �L� *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. Home Improvement Contracto License is required. ,nature orms:expffitrg ise063004 Page 7 of 7 CAPI:ZZ.IHOME.I.MPROVEI%ENT I IC. S P ECI:FICAT IONS.mND ESTWATES STATE OF MASSACLiUSETTS LETTER OF AUTHORIZATION TO APPLY FOR A BUILDING PERI«FT I. E )Jp_AL___pn 'Q J OWN THE PROPERTY LOCATED AT Q�� 1 m f ) IN I t l MASSACHUSETTS. I HAVE AUTHORIZED CAPIZZI HOME IMPROVEMENT TO ACT AS tin AGENT TO APPLY FOR A BUILDING PERMIT IN ACCORDANCE WITH 780 CMR,THE MASSACHUSETTS STATE BUILDING CODE_ I GWE MY PERNUSSION TO LESSEE TO APPLY FOR A.BUILDING PERMIT IN ACCORDANCE WITH 790 CMR;THE MASSACHUSETTS STATE:BUILDNG CODE. a SIGNATURE OF OWNER: OWNT ER'S ADDRESS: OWNER'S TELEPHONE: LESSEE'S SIGNATURE: LESSEE'S ADDRESS: LESSEE'S TELEPHONE: APLLICANT°S SIGNATURE: APPLICA VS AbDRE-SS: 164 etc\,,m Rd., Cotuit.'MA 02635 APPLICAi�IT'S TELEPHONE: 508-428.-9513 RESPONSIBLE OFFICER: ' RESPONSIBLE OFFICER ADDRESS; RESPONSIBLE OFFICER TELEPHONE: Gp, P IZ2 Home j Improvement Inc. I, Gary Gustafson, Production manager:Of Capizzi Home Improvement, hereby authorize Lisa Haworth, to sign on my behalf for permit applications filed through the town. Signed: Gary G stafso Date: Lis h _ .Date: 1645 Newtown Road Cotuit, MA 02635 (508) 428-9518 (800) 262-5060 FAX (508) 428-1547 Clisnt*: 47298 CAPIHO;'A ACORD,, CERTIFICATE OF LIABILITY INSURANCE OATE(MM,yOrYYYY, PRODUCER O1r'09fQ7 THIS CERTIFiCAT=IS ISSUED AS A MATTER OF INFORMATION Rogers&Gray Ins. Agency,lnc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 434 RDut6134 HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR P.O.Box 1601 ALTER THE COVERAGE AFFORDED BY THE POUCiES BELOW. SCutrT Dennis,MA 02660-16a1 INSURED INSURERS AFFORDING COVERAGE NAIC Capizzi Home Improvement, Inc. INsuREs.�z National Grange Viutual Ins, CC. Capizzi Enterprisss, Inc. INSURER 3: American Intemational Gr 1 W Newtown Road INSURER c Cotuit, MA 02635 INSURER a COVERAGES RasuRER THE PCLICIES OF INSUR:JA CE LISTED'BELOW HAVE SEEN ISSUED TO THE INSUFLED NAMED ABOVc FOR rHE POLICY PERIOD INDICATED.NOTNO T ISTANDING ANY R=OUIRSMENT,TEOR CONDITION OF ANY CON17RACT OR OTHER DCCUVEVT rr i;RESPECT TO YVKCH THIS CEK,IF!CAT=MAY SE ISSUED OR MAY PERTAIN,THE INSUNCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO AI!THE TEAS.EXCLUSIONS AND CONOITICNS OF SUCH POLICIES.AGGREGA i cc rfS SHC,NN MAY HAVE BEENREDUCED BY PAID CLAIMS. LTR r; TYPE OF IRANCE ?OLICY NUMBER POLICY PECTIN£ POLICY EXPIRA I ION Ai tAl I Y AT='WV ;YY LIMRS A I GENERAL LIABIL17Y MP010707 06108/Q6 106108107 EACH OCCURRENCE $1 000.000 X wNMERCIAL G�NE:AL LIABILITY OAMh G_TO REPIT`D $Sao.aoa I j CLAIMS MADE �OCCUR I I NEED EXF(Any cne pe,s:n; $1 a a00 PERSONAL&AOV NV 7JRY $1,000 a00 GENERALAGGREGA.Tc- $2,00a aoa GErli AGGREGATE WAIT APPLIES FEF r� I I PRODUCTS•COMP/CPAGG $2,000,000 F'GLiCY 1EQi LOC AUTOMOB;L=LIABILITY MY AUTO c )INGL=LIMIT s 'Ez ao dant ALL OWNEDALTOS ' SCHEDULED AUTOS BODILY INJURY $ (Per person) HIRED AUKS NON-OWNED AUTOS SOOILY INJURY $ I. IP^r a=d2t) PROPERTY DAb.AGE $ fPor a,s dent) GARAGE LIABILITY AI TO ONLY.EA ACCIDENT $ ANY AUTO I OTF-ER THAN EA ACC S AUTO ONLY: AGO $ I EXCESSIUMBREILA LIABILITY OCCUR EACH OCCURRENCE $ CLAIMS MADE I i I AGGREGATE $ 11 OkOUCT16LE I RETENTL:N $ I $ $ B WORKERS COMPENSATION AND- 1764953 � 12125106 12125/07 WN-STATU- CTH- ENPLOYERS'LIABILITY TOF7Y IM,S ANY PROPRIETORAPARTNER/ECECUTIVE C E.L.EACH ACCIDENT $500,000 If ' FFIC..d'E^JL�MSER-cX,CLUDED? i .wbe under E.L.DISEASE-��A EMPLOYEE s50Q,000 PROVISIONS ce OTHER c« - E.L DISEASE•POLICY UW T $500,000 OTHER DESCRIPTION OF OPERATIONS;LOCATIONS!Vc'HICLES/EXCLUSIONS ADDED BY ENDORSEMENT SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO NAIL 111 DAYS WRITTEN NOTICE 70 THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KING UPON THE INSURER,ITS AGENTS OR R=e RESc?ITATIVES. - AUTHORIZED REPRESENTATIVE ACORD 25(2001iC8) 1 of 2 #26435 MAW 0ACORD CORPORATION 1983 i ne t ommonwewn of massaenuserts Department Of Industrial Accidents Office of Investigations 600 Washington Street s` Boston, AM 02111 w"-masSgov/dia Workers' .Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Busm.es✓Orgaaization/Ir d vidual): Address: 1645 Newtown.Rand Tel. 428.95181.k 800.262.5060 'City/State/Zip: O e it: e,You an employer? Check the appropriate box: Type of projeet(required): I ain a employer with 4. ❑ I am a general cont].fficiT nd I 6. ❑ N ew construction ! ezoployees (fall and/or part-time).* hia q hired.fjie sub= tors 2.Q I ata,a sole piopnetor or partner- listed on time aftacfie $ Q iZeniodelingship`and have no employeeso 8. ❑ Demolition tivog.for nme m any capacity. workers' cbnip N9. ❑ Budding addition .[No wo leers' co�i_ insurance 5 Q We�e a corporatiosregaireii] officers have egercir 30.❑ Electrical repairs or additions 3.Q I a� a homeowmr doing all work right of exeniption.p I I.❑Pluinbidgrep"-6 or additions myself[No workers' oo>jap. c. 152,.§1(4) and weno 12`❑Roofreiairs insniance requied t •.eiiploy�es;:{Norwokeis' c?zip ;�ictrrar Ce S aired I 13 ❑`Otht r *?buy applicant$mat clieclts.liox 1>must•also f II:but t ie section below:shoi�'i l-lieir woiiceis'"cb p8nsation policy mfo=afioa' f Homeowners vihb sub�it$ns affidavit mdicafing fey axe doing sIl.w ...and Then hne outside corittactoxs.must S-Lim mt a new affidavit wid;: ting suclh , . : _.. Contractors Fiat cfieck this boa must sYfsclied an addiiiorial sheet shdwing die name ofthe sub contracfors'and flieir.woi ceis'.co�p policy diniatibn I ain rnz.employer that is pr.ovtding workers',compensation:riisuraizce for inj,einplayees $e�omv is the poliey;;irrd joi'i site in ormmrorz n.� Policy#or Self-ins. Lic. qE E tion Date: c gP Job Site Address:. CitylState/Zip: attach a copy of the wo,rkers'.compensation policy declaration page(shovvingthe:policy nninber and expirafoin date). aihire to secure coverage as required under Section 25A of-MGL c. 152 can lead to time imposition of crinminaipenalties of.a Me.up to$1,500_QO and/or one-year imprisonment, as well as civil.penalties in time form of a STOP WORK.ORDER aiid.a_fine )N'.to$250_60 a day against e;crioiatnr.'::Be advised flint a copy 6 this stateD ent may.b6 forwarded to time d£fice.nf nvestigations of the.DiA foi inc„Tarite coverage verification -do hereby andpena'ties ofpe ry.tlrutYlze i formaiionprovidedabove is true and correct �. Date: 'hone Off ial use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/Li-cease m Issuing Authority (circle one): L Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector 6. Other C_ntact-.Person:__.._.._..-- - ---......__. -- -----._. _. .._ --.. ...._._ �. ..... ... . . . .• . .._. . . _... .. ._....._.._ .. .. ..___ ..._. . ��ie TJa�nirrzort � o`'�'�l /�to Board of Building Regulations and Standards Construction Supervisor License i License: CS 74640 Birthdate: ?1/29/1975 Expiration: 11/29/2008 Tr# 6430 J-,LZ Restriction: 00 GARY GUSTAFSON 8 SHORT WAY SANDWICH,MA 02563 Commissioner I . ✓fie 1°a���nnoniueal� a�,./�actutaeltb Board of Building Regulations and Standards License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registratioii-4�,00740 Board of Building Regulations and Standards Expiration 23/2008 One Ashburton Place Rm 1301 � t= =' �= <t• Boston,Ma.02108 ;q ype--Supplement Card CAPIZZI HOME I- ROVEMENT I` pyr f € -4 bARY GUSTAFSON"-.- 1645 Newton Rd. Cotuit,MA 02635 Administrator N t valid'wit hq t Sig 7 tore -co Board of Building Regula ions and Standards One Ashburton Place - Room 1301 Boston, Massachusetts 02108 Home ImprovementJContractor.Registration ------ Registration: 100740 ;.. == Type: Supplement Card m Expiration: 6/23/2008 CAPIZZI HOME IMPROVEMENT,`INC-=-mow GARY GUSTAFSON T , 1645 Newton Rd. y\ i f Cotuit MA.02635 - �,,_. Update Address and return card.Mark reason for change. )PS-CAI Cr 50M-04/05-PC8698 Address ❑ Renewal ❑ Employment ❑ Lost Card Town of Barnstable oFt� Regulatory Services c Thomas F.Geiler,Director saiixsresi,E, Building Division M' $ Tom Perry,Building Commissioner i6jy. �0 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us ffice: 508-862-4038 Fax: 508-790-6230 Approved: Fee: Permit#: HOME OCCUPATION REGISTRATION Date: S 15.10 5 Name: LUIiore. lei. f""Ycui Phone0: 508- 4,18- 59 59 Address: 3 S1 Tu r 1 e_b a ek R d Village: 1A cars tb n s Mill s Name of Business:_ &eac.nast Ed Cational onsuliants Type of Business: U Y1 S U 1 1 yl 4 Map/Lot: b(o J - O`-15 C/ 1 5)'1 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$hall 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 no more 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. ' i • 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 nominal 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 is 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 shill not be include . • . No person shall be employed in the Customary Home Occupation who is not a permanent resident of the dwelling unit the undersigned,have read and agree with the above restrictions for my home occupation I am registering. applicant: s - Y .t1`1 Date: 8 a a o 5 iomeoc.doc Rev.5/30/03 YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates(cost$30.00 for 4—years).. A business certificate ONLY REGISTERS YOUR NAME in town (which you must do by M.G.L. - it does not give you permission to operate.) Business Certificates are available at the Town Clerk's Office, 1st FL., 367 Main Street, Hyannis, MA 02601 (Town Hall) DATE: 8123110 5, Fill in please: APPLICANT'S YOUR NAME: L Frew BUSINESS YOUR HOME ADD ESS: 3 S-I 1E;t rile ask d• 0 508-�taa-5959 MaV-Sions NUIS MN OaU-48 MIR M TELEPHONE # Home Telephone Number 50 8 - 4 a 8 - 5151 Cett:50 -�131-ob38 NAME OF NEW RUSINESS'Se.QCOGM EdU60itionak o u S TYPE OF BUSINESS on5ul� inn IS THIS A HOME OCCUPATION? YES ENO Have you been given approva.I from th ia':'bui Iding'div is'ion? YES.'. NO Y, ADDRESS OF BUSINESS 381 TurVItback. f�d• MgmtzyiS. Nk(US MAP/PARCEG:NUM;BER . N0 3 A0 When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St.—(corner of Yarmouth Rd. & Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town. 1. BUILDING COMMISSIONER'S ICE This individual hates n inf ed of any permit requirements that pertain to this type of business. Authorized Si at a" COMMENTS: (Piz 2 2. BOARD OF HEALTH This individual has bAp informed of the pe quire s that pertain to this type of business. Authorized Signature" COMMENTS: 3. CONSUMER AFFAIRS(LICEN$ING AUTHQf;qTY) This individual.ha a info o the Ian in uirements that pertain to this type of business. Authorized Signature"" 1 COMMENTS: Assessor's offioe .0st floor): THE TO Assessor's map and lot number .................. ......................... �Q Board of Health (3rd floor): d , Sewage....Permii: number ..... ..... Engineering':. r.m ht 3rd floor): rasa pp f63q. \0� House nC�rnber. . .': . .. . ..... ............................................ �o spy a. APPLICATIONS'''•PROCESSED 8:30-9:30 A.M. and 1:00-2:00 P.M. only TOWN— OF BARNSTABLE BUILDING !INSPECTOR r (( yy�� .(( .Cl f.. .... .. 'J.......................................... APPLICATION FOR PERMIT TO ........... .(1.1.1 A............ ...............G� TYPE OF CONSTRUCTION .. M .........................J . ..�.6....... 97... TO THE INSPECTOR OF BUILDINGS: ^ j The undersigned hereby applies for a permit according to the following information: ... Location ..... .$ .... V .. ..tr........ft . .. ....... ........... .> �!!!1.5... .!.�.!. ....... ............. Proposed Use• ........ Zoning District ...R. ...................................... .................Fire District ... .t..�....!... . ............................................ Name of Owrier � 1.S.GnR(.....r,�. ...........................Address 1. ��. .1..�F ...�)�.c .....^.S.l......................... Name of Builder ( l l 11 ........................Address ����^.4�t. .�.�c�n! p.�..11.................. a�.5�.u../ys..�/.�l.S'. Name of Architect ... ........ ...................Address v. S.S...................................... ...... ...... Number of Rooms ...................... ..........Foundation A:0.I`......1`-13 c .......................................... Exterior ...V 1�...✓.�t . ..4.!�.\.....Y�.��.. ,...C.L.C�1�1.!!................Roofing .. .. .! .1F1.. ................................................... FloorsC.. .!n.SQ. ...............................................................Interior .......................:.................................. Heating ...1....` ,..W........D�t.... .`...!. Plumbing )'4 d,N��, .......................... ..... ...... ............................................................. Fireplace .....k4ay . z.............................................................Approximate Cost .....�0 ,�,v 0 Definitive Plan Approved by Planning Board --------==----------------------19-------- • Area ....�.......................... Diagram of Lot and Building with Dimensions Q`�—� Fee ...- .................. SUBJECT TO APPROVAL OF BOARD OF HEALTH Ca 0A- P,00 OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to oil the Rules and Regulations of the Town of Barnstable,regarding the above construction. 0 - Name ..........."`!!.`...\............ t Construction Supervisor's License .�.Q.. ..�.C.�........... FREW, NELSON 'A=063-045 No ...31503 permit for ...Build Addition ........................... Dwelling,,,...,.. ..... ..... .. 'Location .....3.8.7....Tu.r.tl.e.ba.c.k...Ro4.d......... .... .. .... .. .... .. .. ..... Marstons Mills ............................................................................... Owner ..........Nelson...Frew............................ .... .. . .. .. Type of Construction ....Frame......................... .. .... .. .. ............................................................................... Plot ............................ Lot ................................ Permit Granted .... December 16,....................................19 87 Date of Inspection .....................................19 Date Completed ......................................19 Assessor's map and lot number ............................................ Q ypi TN E TOE Sewage Permit number ........................................................ Z BAUST"LE, i House number 9 MADa 0 000,i639. \0� �EQ VAI a' TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO ............................................................................................................................. TYPEOF CONSTRUCTION ..................................................................................................................................... ................................................19........ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ....................................................................................................................................................................................... ProposedUse ............................................................................................................................................................................. ZoningDistrict ........................................................................Fire District .............................................................................. Nameof Owner ......................................................................Address .................................................................................... Nameof Builder ....................................................................Address .................................................................................... Nameof Architect ..................................................................Address .................................................................................... Numberof Rooms ..................................................................Foundation .............................................................................. Exierior ....................................................................................Roofing .................................................................................... Floors ......................................................................................Interior .................................................................................... Heating ..................................................................................Plumbing .................................................................................. Fireplace ..................................................................................Approximate Cost .................................................................... Definitive Plan Approved by Planning Board ---------------__—-----------19________ . Area .......................................... Diagram of Lot and Building with Dimensions Fee ............................................. SUBJECT TO APPROVAL OF BOARD OF HEALTH I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name .................................................................................. ' rfttw° Nelaon0K° A=63~45 i - 20383 tool shed � ! No ................. Permit for ------------ - . � ---------.----------------.. / 387 Turtleback Road . Location .------------.-------- � ` ' Marmtxmum Mills ' --------------------------. � Nelson M. Frew ' . Owner ........................................................ ` ' frame / Type of Construction .......................................... ' --------------------------' ; Plot ............................ Lot ----------' � � / � July 13 78 [ Permit Granted -----.�-------]9 � � . � � Date of Inspection ------------lV � ' Dote Completed ------------'l9 � � ' PERMIT REFUSED � _. —� lV � � ---K ' ^--.------..—.--.^.. ................................. / ` ' ---..—.—.-------------.—..---- ------`------~—^'----^'—'----' . � { � -_-------------- 19 ! Approved --------~----`--'—^'--------' � ------------------''~—'^'----^ ' Assessor's offioe .0st floor): SYSTEM BUST Rfl HE Assessor's map and lot number .................. .. .;® ON ®MP�.IANC'...............::...... Board of Health (3rd floor): �Pd Sewage., . ewage..Per.mit - . , n,..•; num. ber ............................... i G . +aoB AUSfADaL� E Engineering'. e r 1 RE CODE Mb ,r.tm s9' House ntmn r. . ........................................................ f REGULAT0® ♦��YAK APPLICATIONS'"PROCESSED 8:30-9:30 A.M. and 1:00-2:00 P.M. only TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO .........D. L . f1.d. (... .� rid: ......................................................... TYPE OF CONSTRUCTION ......... ..0..-; ....:7... J. YA../V4............................................................................ ....................12.1.-fk....... 9. �- TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ..... �..... uV► ..�.1:......•U.JtH-G........p4.......... �►1 .tip C�U1f. .. t .!:5....................................... ProposedUse .......�L�. ..��..1.1�i.�r......................................................................................................................................... Zoning District ....YN. ..........................................................Fire District ...�..A..11....r...�4�I.... Name of Owner .\�k.. .S.i�.�{.....C..<.`.�T�!1 ............................Address ?�. ►J{{r� ..\Si....!lD .........y��.�......................... Name of Builder OW........................A d d r e s s .. .(Q.... y •r Name of Architect ... .I:.!C........ ..................Address A—c—kat1c.:... �d1 .` ...................................... Number of Rooms ....... -- 4t _.............. . .� ...............Foundation t.�..........�Q t? `/� ..A,41 c (� f h Exterior ...1�'..�.✓� .�..�. �....&Rk....ti H..�1 � ................Roofing .. 5..' Y1..d�1.. .. ................................................... i Floors ...C..A ............................................Interior �•\'�1:.`'i �.r�.•.!!�.............................................. Heating ..f...\ ..V�.........D .... .`.�....................................Plumbing .....1U.I1 ............................................................ Fireplace .....4 o..k.-k..............................................................Approximate Cost ..... IV 12 Definitive Plan Approved by Planning Board -------------------------------f 9 Area ........................ Diagram of Lot and Building with Dimensions i . Fee ............................................. SUBJECT TO APPROVAL OF BOARD OF HEALTH a�- C a o aoo ' Y OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. n Name "�.!!.�..�... . .... Construction Supervisor's License �.Q.....(0..I-1-,............ FREW, NELSON Build Addition No .31503................ Permit for .................................... Single Dwelling ........ ..... ..................................... Location ....387 Turtleback Road ............................................................ Marstons Mills ............................................................................... Owner ......Ne.l.son...Frew .................................. .... .... .. .. .. .... Type of' Construction ..Frame.......................... .............................................................. ................ Plot ............................ Lot ................................ Permit Granted ..,December 16.,....,_,g 87 ..................... Date of inspection, .............. _oMMAE�., Date Completed ........ -:5�1 9 a � tssoil.4 map and lot number ) .. . .............. ..... ............... SEPTIC SYSTEM MUST BE INSTALLED IN COMPLIANCE , WITH ARTICLE 11 STATE Sewage Permit number "'••/••"""' SANITARY CODE AND T.QWN ypF TM E T�� TOWN OF .' BARATAB�LE� • EASB9 TAME. 1 1039.a'. BUILDING, INSPECTOR �'0 YPY APPLICATION FOR PERMIT TO ..... IJLcr.�:.....�r."'�.. �.............. .... .. ....................................... ....... .... TYPE OF CONSTRUCTION ....... � ,E_ ................................................19........ TO THE INSPECTOR OF BUILDINGS: } The undersigned hereby applies for a permit according to the following information- Location . ...........71M<l!~-i= 4.1 ...... f ...........Nl /1 .1.4.6r1S'.....wl.(. . ............................................... ProposedUse .......................................................................................................................................... ZoningDistrict ............ F...........................................Fire District ............................:................................................. Name of Owner / �C�<... :�-S �r.�....... 2 LZ. ...........Address ..1 AILIV .....�4,t,�r ........ �7L ...... ..... ADAmS SNnRt:�- CD�t7 e� Name of Builder .... .. .r G qj-S T< B20�!e- /.�'M./.�f.P!(/�1......Y.,G.!�!tl�........................Address 4.7.........}�P�................... ....... ...4'-............. .... Name of Architect .......(.C-!:.............Address ............ '<.���SS:............................... Numberof Rooms ............t1.....................................................Foundation .... ............................................. Exterior ...(t/00.:41.....�!l..*O14/67........................................Roofing :.14C7. f.17.......................................................... ail T' Interior ..„ .12 Floors ...GQ.11i��...'....-................/......lfl0 .�lv! L. ......................................................... HeatingY.994C.`b......!'rl?1.........Ld,.lh1:.5�....................Plumbing ........................................................ Fireplace ... .1`. ......................................................................Approximate Cost ..7.v1.vo........... ..................... . �....... Definitive Plan Approved by Planning Board -----------_______-----------19_______. Area .........././U....`�. ............ Diagram of Lot and Building with Dimensions . Fee � ro sa .......... .................................. SUBJECT TO APPROVAL OF BOARD OF HEALTH _21 LOT S'!®C- 1-07 v W S CLA Cis ® � /� �r= � Negu r Y a9I here ree to nfordi to all the Rules nd tio o the Town of Bar stable regarding the above co struction. Name". '!. .....� .c , Frew, Nelson ZV,q 16706 two story... ............ . 0 ................. Permit for ..................... .. ....... single family dwellin ........../... ..... ............ Location UQ. TurtlebackRad .... .......................................................... Earstons Ydlls .................................................. Owner .............Nelson Frew ..................................................... Type of Construction .........frame...................... ................................................................................. Plot ...... 69 ....................... Lot ........... ................. Permit Granted ......flojember 2 .... 73 Date of Inspection .... 01-r 75 Date Completed ..................................... PERMIT REFUSED ................................................................ 19 ............... ......................................................... ................................................................................ ............................................................................... ............................................................................... Approved ................................................. 19 . .................................................................................. ............................................................................... r 4C) 30 CO a oa�2S. Is w ') P/7' P.-T ( v is TL.c 1-3/9Ck, .M ;9/2 S Tolvs A S Ki -72 1� Assessor's map and lot number .......................................... �C� yoFTNeT a ' o y SEPTIC SYSTEM MUST B �Q o Sewage Permit number •• INSTALLED (N COMPLIAN e . 3$� WITH ARTICLE 11 STATE Banes ts, House number v 0 � ....................................................... SANITARY CODE AND JTO 4A i639. \0� TOWN OF BARNSTABLE 1- .., a J � .y N BUILDING INSPECTOR � t� yAPPLICnATION FOR PERMIT TO ...... i Eb �6 T Y � ..........V ........:.......... o TYPE OF CONSTRIXTION ...............�n►..?.4 ?...1=fL!aME........... .. co f V►Y + ..........................................I�-..19 . TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ....... 3............................................R?7 �1� �� . .........MfIQ.?TS� ....M�l-�.S ..... .... ............. ............ ProposedUse ......... TO a ............................................t ....1.....:..Y. ..1.o...1,3 ..C ......................................................... ZoningDistrict 1 .............................Fire District .......0 ()...................... .................. .................................................................... Name of Owner ....N K�0.ti....M'...D .....................Address 1 V fLxL r..3 A V V:. R:�....Mms* Yh LLS �. r Name of Builder ....... .... ' ......5...fl o .....................Address .......�.A.N' 54!....M...� Y. r................................ Name of Architect ................Address .................................................................................... Numberof Rooms .............N. .............Foundation ................................ ...................... ....................... 51�1tVG....................................Roofin f�� t�TL`t 51A1N4 ,. -:................... Exterior ab� g............... ... ............... ................... ......... Floors ceq!4 ...................Interior -N F 1 N tsAe3> .................................................................... N. Heating ............. 6.14 Y.............:..........................................Plumbing ...............N6W.�4-.f............ ....................................... Fireplace6'N� .........................Approximate Cost ........ ..a. `...................... ..:.................... ..:............... .................................... Definitive Plan Approved by Planning Board -----------_______-----------19_______. Area �V D Diagram of Lot and Building with Dimensions 5�, � am0"L Fee� ��'—'�" ........................................ SUBJECT TO APPROVAL OF BOARD OF HEALTH I hereby,agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ..... ..�"""""""'... .................................................. Frew, Nels«mmD0" � � ' 20383 tool &md ' No�-----. Permit for .................................... -----'---^-----------------' 387 Turtleback Road Location_ -----------.—~-------.. ' Mars Hills .--------------.~----.-----.. Nelson M. Frew . . Owner --------------.-------. frame Type of Construction -------------- ' . ^ -----~---.----..�-----------. � Plot ............................ Lot ----------' ' ' . � July 13 78 .Parmif Granted ----........------.]q � Dote of Inspection ............. bate te Completed ----.. ����.,.]V�� c� ` � . . - . PERMIT REFUSED ................................... ............. .............. lP .-----------.-------------- ' � . —'---^''^--'--------~'—r------'' � ............................................................ ................... ----..---.—.-----..----...--...^— Approved - � ................................................ lR ` . ' -------'------'------'—^---'—' � ` ~ ` ' � � � ---`----.---.-------.—~.--..-.. � ` 47 ul z LA T 3 �n NL5,;, b, (0" X15,