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0268 TOWER HILL ROAD
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A � � � � � a K�.��I��U A�ql ..i,., l o4r". ���� ,!4 ` �r�' , a�..�.,iiA.� ri'.a � �d^"��A��( ''."..( � ��"� � y, •�t$ _���Rr��% TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel TOWN OF BARNSTABLE Application # Health Division - . Date Issued Z� Conservation Division Application Fee 9•V Planning Dept. Permit Fee 0 Date Definitive Plan Approved by Planning Board �� Historic - OKH Preservation/ Hyannis I Project Street Address 0 1�- . I Village A J. L Owner cy Address S�r-,c Telephone 9 A 4(66 Permit Request �_N)j.1 �le 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 -U"" Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑ Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area(sq.ft.) . Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing —new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use _ Proposed Use — APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name Alike Telephone Number P® Box 52 Address License # West Dennis, MA 02670 Cell (509) 280-6964 Home Improvement Contractor# - 3 Email Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO Al SIGNATURE DATE Y _ FOR OFFICIAL USE ONLY - APPLICATION# DATE ISSUED MAP/PARCEL N0. r R '. ADDRESS VILLAGE - OWNER w.. i DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL 'j PLUMBING: ROUGH FINAL GAS: ROUGH- FINAL FINAL BUILDING r DATE CLOSED OUT ASSOCIATION PLAN NO. Town,of Barnstable Regulatory.Regul4tory. Sex vices Wnsz• ' kichard.V..Sc Director . g Buili�ing Division . Tom Yeriy,Building Commissioner 200 Main Street;Hyannis;MA.02601 vn*W town;barnstable_nmus Office: 508=862-4038 Fax: 508-790-6230 Property Owner Must Complete:and•Sign`ibis Section If Using ,.A.Builder I, C ' �- c� Y► y/ ,as otvne of the Tsiibject properly hereby.authorize Ml--QXA�AA I0O to act,on rnybehalf- in all matters relative-to work authorize .this building permit application for. g� �r7 U��r• l�- ,'L] �o�, D S���v, ]��� � a-6 ys' . •{A�ddress�of j�ol)• " 'Pool fences and alarms.are the resporisi6iliry of the applicant. Pools are n&to be.filled or utilized-beforc-fence is installed and all final inspect ons are performed and accepted_ Signature of Owner Signature of Applicant 1?zint.Naine PrintNanie Dare Q:FORMS:ONVh1 IiPERMISStONPOOLS Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement'Contractor Registration Registration:' 169393 =: = Type: Individual Expiration: 6/16/2017 Tr# 264961 MICHAEL MCCARTHY MICHAEL MCCARTHY P.O. BOX 52 - -- WEST DENNIS, MA 02670 - — Update Address and return card.Mark reason for change. SCAT 0 2oM•os�tt Address Renewal Employment s Lost-Card �e (Onnumzn-ruurtijC/n�'O/fifao:;ua/ruetlt \ Office of Consumer Affairs&Business Regulation .License or.registration valid for individul use only � OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: jRegistration: Type: Office of Consumer Affairs and Business Regulation Expiration: ;fi%16%2q 1,7 Individual 10 Park Plaza-Suite 5170 Boston,MA 02116 MICHAEL MCCARTHY::::..; MICHAEL MCCARTHY::';"_!�`:. 6 RANGLEY LN. SOUTH DENNIS,MA 02660 Undersecretary ` Not id with oft signature Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supervisor License: CS-058633 MICHAEL J MCC�IRUM PO BOX 52 W DENNIS MA 02671 ia , I � �1J_J� )I) � Expiration Commissioner 04/10/2016 f The Commonwealth of Massachusetts Department oflnfktstrialAccidents 1 Congress Street,Stiiie 100 Boston,MA 02114-20I7 www mass gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/ElectriciansfPlumbers. - TO BE FILED'WITH THE PERMITTING AUTHORITY.: Applicant Information Please Print Le ibly Name (Business/Organization/Individual): Mike McCarthy ConStructi6n ox Address: West nennis, MA 02670 City/State/Zip: Cell 08)#280-6964 _ UIC-169393 Are you an employer?Check the appropriate box: Type of project(required): l.fama employer with 5— employccs(full'and/orpart-time).• 7 ❑New construction 2.0 I am a sole proprietor or partnership and have no employees working for me in 8. Remodeling any capacity.[No workers'comp.insurance required.] 3.a 1 am a.homeowner doing all work myself.[No workers'comp.insurance required.]t 9• ❑Demolition 4.n I am a homeowner and will be hiring contractors to conduct all work on my property. I will 10 Q Building addition ensure that all contractors eitherhave workers'compensation insuranceor are sole I].Q Electrical repairs or additions proprietors with no employees. S.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 12. Plumbing repairs or additions These sub-eonlractors have employees and have workers'comp.lnsurancyt 13.❑Roof repairs 6.❑We are a corporation and its officers have exercised(heir right of exemption per MGL c. 14. Other b✓C.# 152,§1(4),and we have no employees.[No workers'comp.insurance required.] •Any applicant that checks box fil 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 hive 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 ant an employer that is providing workers'compensation insurance for my entployees. Below is the policy and job site information. M Insurance Company Name: Policy#or Self-ins.Lie.#: )c-,- -(G Expiration Date: )1 )ts- f/ 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 MGL c:152,§25A is a criminal violation punishable by 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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby cerfyAlr alties ofperjury that the information provided above is true and correct Signature: Date: Phone#: ( C4 mac,—C VC t 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#: I - CERTIFICATE OF LIABILITY INSURANCE °;tio„20116 Y' THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND, OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder'is an ADDITIONAL INSURED,the'policy(ies)must be'endorsed: If SUBROGATION IS WAIVED subject to .. " the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER 01962-001 CONTACT Bryden&Sullivan Ins Agcy of Dennis Inc N/d� o.Et): (508)398-6060 No„ (508)394-2267 PO Box 1497 MM: So Dennis,MA 02660 INSURER(S)AFFORD NG COVERAGE NAIC# INSURER • A.I.M.Mutual Insurance Company -33758 INSURED INSURER B: Michael McCarthy Construction Inc INSURER P O Box 52 INSURER D West Dennis, MA 02670 RE COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE.POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY 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.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. IRR TYPE OF INSURANCE I SR POLICY NUMBER MNUDMIVIIDD LIMITS 1 K GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGESI RENTED $ P E a CLAIMS-MADE OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ EN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ OLICY ---'PROT OC COMBINED SINGLE LIMIT $ AUTOMOBILE LIABILITY a c'W ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS UMBRELLA UAB OCCUR EACH OCCURRENCE $ EXCESS UAB CLAIMS MADE AGGREGATE $ DED RETENTION $ $ V8ffiRf&ffSVt%j 4f� X ,BMWs Dit 11: q�PR�ETp�ppR7�.�ER�� Y/ E.L.EACH ACCIDENT $ 1,000,000.00 A o�ICER/MEMBER EXCLUDED? CIITNE Y N/A VWC-100-6017656-2015A 12/15/2015 12/15/2016 (Mandatory In NH) @� E.L.DISEASE-EA EMPLOYEE $ 1,000,000.00 g�gScI�IPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000.00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,H more space Is required) CERTIFICATE HOLDER CANCELLATION Cape Light Compact PO Box 427 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Barnstable,MA 02630 THE EXPIRATION DATE THEREOF,' NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE &,ea ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010106) The ACORD name and logo are registered marks of ACORD L i TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map I V, Parcel O� 7'4N:`0F .BARNSTABLE Application # Health.Division ',;; S Date Issued I5 Conservation Division Application Fee -06 Planning Dept. _ Permit Fee ,s•t,1SION Date Definitive Plan Approved by Planning Boarrd Historic - OKH _ Preservation/ Hyannis Project Street Address owce- Village rw-tr UJ 14- Owner Ar- ;Z Address t,.. Telephone G Permit Request Wc-44-,r.Z-41 cc��.-���2. Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 6av Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family 53,,, Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: 0 Yes ❑ No Basement Type: ❑ Full 0 Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes 0 No Detached garage: ❑ existing 0 new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) NameCon-m-F-1-8-etiOn.IV!ike McCarthy Telephone Number Address PO Box 52 License # West Deminisq MA 02670 Cell (508) 280-6964 Home Improvement Contractor# Email Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE //y�� + FOR OFFICIAL USE ONLY APPLICATION# *' DATE ISSUED x MAP/PARCEL NO. C ADDRESS VILLAGE - OWNERi DATE OF INSPECTION: C FOUNDATION FRAME INSULATION FIREPLACE t; ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. 'y Town,of Barnstable °. RegtiYatory. Services Richard V.St.*Director ,,,D<• . Building Division Tom Perry,33uildin9 Commissioner 200 Main Street,Hyannis,-MA 02601 -,vmYAowu.barnstable_=.us Office: 508862-4038 pax: 508-79076230 Property Owner Must Complete and Sig TMs Section. If Us ing:.AA Builde r as 4,0nei.-of the-subject propeny h=bp.authorize c S� I01'1_) to act on my behalf, in all matters relativc to work authorize •this building permit application for: {A:d&es§of jot )-• Pool fences and alarms.are the responsibihV-of the applicant. Pools are not'to be.filled or utilized-before•fence is installed and all final inspections are pe'rformed,and accepted. Signature-of Owner Signature of.AppRc=t Ti nt.Name Print Name Daze. g b, 4, Q;FORMS:O WNW ERMISSIO lPooLs l -- f Massachusetts - Department of Public Safety Board of Building Regulations and Standards Construction Supervisor License: C"58633 T r' MICHAEL J MCCAR PO BOX 52 W DENNIS MA 6267 o-� Expiration Commissioner 04/10/2016 Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contfactor Registration Registration: 169393 :_ ---�= Type: Individual Expiratio / Tr# 264961 MICHAEL MCCARTHY MICHAEL MCCARTHY i P.O. BOX 52 -- WEST DENNIS, MA 02670 Update Ad ess and return card.Mark reason for change. 20M-05/71 Address Renewal L=I Employment Lost Card The Commonwealth of Massacllllsetts Department of InthistrialAccitlents I Congress Street,Suite 100 Boston,MA.021I4-2017 www.mass.govAlia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Pitimbers. TO BE FILED WITII THE PERMITTING AUTHORITY. Applicant Information lease Print Le ibl Name(Business/Organization/Individual): Mike C a y nO BMX G-,, Address: West Dennis, MA 02670 e -1611111,11111614. City/State/Zip: C- it-48 6M#: HIC-169393 AYl'.m an employer?Check theapropriate box: Type of project(required): 1. a employer with employees(full and/or part-time).* 7. ❑New construction 2.❑1 am a sole proprietor or partnership and have no employees working for me in 8. Remodeling any capacity.[No workers'comp.insurance required.) 3.Q 1 am a homeowner doing all work myself.[No workers'comp.insurance required.)► 9• ❑Demolition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will 10❑Building addition ensure that all contractors either have workers'compensation insurance or are sole I LE]Electrical repairs or additions proprietors with no employees. 5.❑1 am a general contractor and I have hired the sub-contractors listed on the attached sheet. 12.❑Plumbing repairs or additions These subcontractors have employees and have workers'comp.irtsumnce,t 13.Q Roof repairs 6.Q We are a corporation and its officers have exercised their right of exemption per MGL c. 14.dOther 152,§1(4),and we have no employees.[No workers'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 Im 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: ATM rM M, 4"1 Policy#or Self-ins.Lic.#: 110u-1&0i 70_( Ld11 �' Expiration Date: )a t- 1ri Job Site Address: �r;� fic�,.� ��.� 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 MGL c. 152,§25A is a criminal violation punishable by 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.A copy of this statement may be forwarded to the Office of investigations of the DIA for insurance coverage verification. I do hereby cerftfy Ern tl nI s and allies r" ry that thernformation provided above is tare and correct. Si nature• - Date: Phone#: — Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: f WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY INFORMATMPAGE A.I.M. Mutual•Insurance Company 54 Third Avenue, Burlington, Massachusetts 01803-0970 (800)876-2765 NCCI NO 26158 POLICY NO. I VWC-100-6017656-2014B PRIOR NO. VWC-100-6017656-2014A ITEM 1. The Insured: Michael McCarthy Construction Inc DBA: Mailing address: P 0 Box 52 FEIN:*****3862 West Dennis,MA 02670 Legal Entity Type: Corporation Other workplaces riot shown above: See Location. 2. The policy period is from 12/15/2014 to 12/15/2015 12:01 a.m.standard time at the insured's mailing address. 3. A. Workers Compensation Insurance: Part One of the policy applies to the Workers Compensation Law of the states listed here: MA B. Employers'Liability Insurance: Part Two of the policy applies to work in each state listed in item 3.A. The limits of liability under Part Two are: Bodily Injury by Accident $ 500,000,.each accident Bodily Injury by Disease $ 500,000 policy limit Bodily Injury by Disease $ 500,000 each employee j C. Other States Insurance: Coverage Replaced by Endorsement WC 20 03 06 B D. This Policy includes these Endorsements and Schedules:- SEE SCHEDULE 4. The premium for this policy will be determined by our Manuals of Rules,Classifications, Rates and Rating Plans. All information required below is subject to verification and change by audit. Classifications Premium Basis Rates Code Estimated Per$100 Estimated No. Total Annual Of Annual Remuneration Remuneration Premium INTEA 0712979 INTER SEE CLASS CODE SCHEDULE Minimum Premium $550 Total Estimated Annual Premium $29,332 GOV GOV Deposit Premium $7,748 STATE CLASS MA 5479 State Assessments/Surcharges $28,601.00 x 5.8000% $1,659 This policy,including all endorsements,is hereby countersigned by 12/15/2014 Authorized Signature Date Service Office: Bryden&Sullivan Ins Agcy of Dennis Inc 54 Third Avenue PO Box 1497 1 Burlington MA 01803 So Dennis, MA 02660 F�� WC 00 00 01 A(7-11)Includes copyrighted material of the National Council on CompensationInsurance,used with its nermissinn. 'TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION. Map I Parcel o`''I I Application # C 02 Health Division Date Issued Conservation Division Application Fee Planning Dept. Permit Fee DU Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address a 06 tA t\k 9� Village Q Owner ArVv1Vr Mc4mZq Address rid6 6t e l ftll Telephone i�oc-6— 60 o Permit Request 94 MQN�- - 0C4Skyka\ Wcx)� 5vn CA- C,J Ce-62 1'c CC Square feet: 1 st floor: existing3315 proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 0 UVO . Construction Type Lot Size 01 ke-C-e-5 Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old Kin g�s;Highway-:O Yeses Ell No Basement Type: IN Full ❑ Crawl ❑ Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.fts Number of Baths: Full: existing_ new Half: existing new Number of Bedrooms: existing _new `- Total Room Count (not including baths): existing 6 new First Floor Room Count Heat Type and Fuel: XGas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes WNo Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: )$ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review # Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name MA C Y, U o `�A^cy- Telephone Number Address P.O . boK (a g Cdkvik /Ll�. License # J ONO, IC(SS sv%kyt�-- ' .Au �-, A-ta• Home Improvement Contractor# Email �k210-C(AAdS0n C0ASkTQCkto^(QJ 9A,441(-004't Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO �eW b,jFUrj -VG�Sc�C • SCILAJw1 Ulm SIGNATURE G'//�'�/v ��� %/mil DATE FOR OFFICIAL USE ONLY U APPLICATION# DATE_ISSUED, t MAP 1 PARCEL N0: ADDRESS VILLAGE OWNER t. - i DATE OF INSPECTION: FOUNDATION C'3�Soed�S o 5 �I FRAME s� ` INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL f ' GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. Rte CarnnrOMWaM of VassachuseM Deparftnent of Indush-ial Accidents Office vflnvestigations 600 WaYhirlgtOn meet Boston,M102111F wn m ma-mgaVdia Workers' CompensafianInsuranceAffiidavit:Buffders/Contractors/FAectricianMumbers Applicant Information Please Print Legibly Name(Sus oes Oq;aniz on&dicidnaq: 11144- V zzm Address f.1/0 ?03� 6Y City/State/Zip: 7 rr_ one4- 5 0 ` — —Are_yan.an.employer?Checktlwappropriatebox: T of project(required):__ 4. I anti a contractor and I —Type lu• ] �c'4' �=- 1.❑ I am a employer with ❑ � 6- ❑New c=sttuctioa employees(full and/or part-time)* have hired d the subcontractors. listed on the attached sheet 7- ❑Remodeling 2._[ I am a sore proprietor or partner- These sub-contractors have ship and have no employees ees md g_ ❑Demolitioa worlang for me in any capacity employees and have workers' 9 ❑Building addition �6.�SrOTIfeIS'comp-insurance comp-mct�ranCF Y re 5. We a a corporation and its 10-0 Electrical repairs or additions required] 3_❑ I am a homeowner doing all work of6rzrs have exercised their 1I_❑Plumbing repairs or additions myself. [No workers'comp- c-1 , 1(4e nd per MGL 12_.� of repairs insurance required_]$ c_152,§I(4},and we hati�e no 13_LI Udier employees-[No Workers' - comp-insurance required.] *Any appUowt that checks boa*1-o=also fill out the section below showing their wagers'compensation policy infiitrmetial- T M.m,W.ers Who submit this affidaft indiicsmtg they ace doing an=*and then hoe outside contractors narst sobmi2 anew affi&T t mcricetiog sach- tractoa that cbeck this baoc most attached an additional sheet duywing the name of the suh-omgrAcb s and stage whether ornot fbnse m&des have omployees. If the sob-cont mctors haee employees,they must provide their workers'comp.policy n uaabrr lam an employer Heat is providing trorken'compensation irmirance for my,employees. Belau is the policy and job site inforrnaliom Insurance Company Name: Policy 9 or Self-ins-Lic.4: Expiration Date: Job Site Address: City/State zip: Atfacb 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 S 1,500.00 and/or one-yearimprisortraent,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 Imirestigations of the DIA for insurance coverage verification_ Ida hereby cacti it t prnn;a penat#es ofpedwy thatfhe information protddsd above is hug and correct (% fit// Date- Phone 5itntattme: M Ub ✓T O ff E ial use only. Da not sprite in this area,to be campleted by city or town oficiaL City or T'own:. PerudVLicense At Issuing Authority(circle one).: 1.Board of Health- 2.Building Department 3.Cityll7own.Clerk 4.Electrical Inspector 6.Plumbing Inspector 6.Other Convict Person: Phone#: 6 Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuantto 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 Iocal 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-contractors)name(s),address(es)and phone number(s)along with their certificates)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance Coverage. Also be sure to sign and date the affidavit The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant- Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit:one affidavit indicating current policy information(if necessary) and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (Le,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: Tbh Commonwealth of Massachusetts Department of Industrial Accidents Office ofkyesttiotiQns 600 Wasynatan strut Boston,NIA 02111 W.#617-727-4900 ext 406 or 1-877MAS E Revised 4-24-07 Fax# 617-727-7749 V1WW.mas,3,gav/dia ATVC Cuide to -Wood Construction irk Higfi F ad Areas: 110 mph Knd Zone - Massach sew ChecklM for COMpiiance(790 cMR5301.Z.1-1)I Loadbearing Wall ConnecfiDns - - - Lateri l(no.of 16d common nails)- (fables 7) Non-:oadbearing Wall-Connections Lateral(no_of 16d common nails)--___.__.---._-(fable B)_-.___-----•----------_--_._� Load Bearing Wan-bpenings(nemrd largest opening but check all openings for compliance to Table 9) Header Spans _. -------------(Table 9)---:---_--__---_---• ft in.511' Sir Plate Spans _-------• -------- ft in 511' Fun Height Studs (no.of ...(Table 9)----------- Non-Lwd Bearing Wan Openings (record largest opening btrt check all openings for compliance to Table 9) HeadeiSpans-.---------._._------...___._.----•--_-_---.(Table 9)-._------------ -_ft—in 12' Sin Plate Spans.___ ------ -----_-_--_-__-_(Table 9)_____----_--___.___.._ft_in.512' Full Height Studs(no.of studs)__.------..- _�_-.-(Table 9)___-----------_-•__-- ____-- Edefior Wall Sheathing to Resist UpFdt and Shear Simultaneausly4 h4inirnum-Sixlding Dimension,W - Nominal Height of Tallest OpeningZ ----------------- -..--_---.--_._-___.--__-.._—�6'Er Sheathing Type______,._-_._.__.____.._(note 4)__,-_--_..-..._____.-_____-._._. -Edge Nail Spacing ------ 10 or note 4 if Jess)_---..____-�. in. Feld Nail ----__-_--_._......(Table 1D)_.__.�-_-_ ------- rn. Shear Connection(no.of 16d common nails)(Table ir.- -- 5%Additional Sheathing for Wan with Opening>6'r(Design Concepts)___.__.._ Maximum Building Dimension, L Nominal Height of Tallest Opening -------------------------------------------------------------------- <_5'6' Sheathing Type__.-.__....------___._._-----_(note ).___.._.�._._--------_.--_-_-•_- Edge Nail Sparing-------------------_____.___--{Table 11 or note 4 if in. Feld Nail Spacing.--------------.___....---_-;.(Table 11):-- -:-----•---------�.._ in Shear Connec5osi(no. of 16d common nails)(Table 11_)__._...__............ _ Percent Fun-Height Sheathing-.--_-_.(Table 11)___.__-_______- S%AddidDnal Sheathing for Wall with'Opening>SS'(Design-Concepts)--..--.----:._' Waif Cladding Rated fDr Wind 5,1 ROOFS Roof framing mernber spans checked?..._-__--__..(For Raftem use AWC Span Tool,see B.BRS Website) Roof Overhang ---------------------------_.------------------(Figure 19).__.:____-_ft s smaller of 2'or Lf3 Truss or Rafter Connections at LDadbearing Walls Proprietary Connectors Uplift.....................-.....-----(Table 12)------------------ - ----Lj-- pi Lateral....._-__-_____________._.(Table 12) pff Shear------------._---:_------(Table 12)--------- Ridge Strap Connections,if corar yes not used per page 21... (Table 13)____----__.--.•---___--T= pff Gable Rake Ouilooker__.------...---:_.:.-_-:-.-------(Figure 20) ..._........_ft-<smallerof2'o'rU2 ' Truss or Rafter Connections at Non4nadbearing Walls Proprietary Connectors Uprdt_____._._-..........___—_-_:(Table 14) --- -_---.----------L� Ib. Lateral(no_Df 16d common nails)__(Table 14)--------------------------------------L . Ib. . Roof Sheathing Type----•--.:.------_____-_--(per TBD.aMR Chapters 53 and 59)............. Roof Sheathing Thickness__._.....-- ---_- -_-- ----_-----__-_-_—in->711r WSP Roof Sheathing (Table 2)----------------:_-------.---------.-.._ f, : This checidisf shall be met in is entirety, excluding the specrTic eXcep5Dn noted in 2, to comply with the requirements Df 730 WR53D 1.2 1.1 Item 1. If the checklist is met in its entirety then the following meted straps and hold downs are,not taquired per the WFCM 110 mph Guide: a. Steel Straps per Figure'S b. 2b Gage Straps per Figure 11 r~ Uprdt Straps per Figure 14 d Ail 5tmps per Figure 17 e_ Comer Stud Hold Downs per Figure lBa and Figure M Exception:Opening heights of up to 8 fL shag be permitted when SnA is added to the percent fun-height sheathing - requirements shown in Tables 10 and 11. The bDtlnm sill plate in exterior wails shall be a minimum 2 in-nominal thicknbss pmssure treated#Z-made. AFDC.Guide to Wood Construction irr ffi�h Kad Areas:110 mph mad Zone' Massachusetts Checklist for Compliance(78o DIR5301 f.I)i - �1 chi 1.1 .SCOPE WindSpeed(3-sm gust)_._---_-_ . _..__._._----:---._._ ..._-.--•---------___._:..... ----_-__--110 mph Wind Exposure Category_.__. ; -..._...--=------_---•----•----_.-____.._..._.. _B Wind Exposure Category................Engineering Required For Entire Project...................:...................C 1-2 APPLICABILITY Number of Stories(a roof which exceeds 8 In.(2 slope shall be-considered a story) stories _<2 stories Rc;af FYr-h Mean Roof Height'_ __-.._ __. _ {Fig 2}_-----.__._--- <' Building Width,W ft gag, Building Length,L ------------ .._.-:_-_---(Fig 3)---------_-__:-_.__--- ft s 80` Budding Aspect Ratio( -Fig 4)---------- _...-- -- g 3:1 Nominal Height of Tallest OpeningZ .._.----•--.--._...__(Fig 4)_..----------.�.---------•--_. 5 6'8` 1.3 FRAMING CONNECTIONS General compliance with framing connections......._._.-.(Table 2)----•--------•-----------•---- ........._..___. 7-1 FOUNDATiDN Foundation Walls meeting requirements of 7BD CMR 5404.1 ConcrIMP.............................................................................................................................. Concrr fe Masonry--•--•-- __._.. :....-- ---_.- -- -- -... --=-----•-•--------•----._.:-. 22 ANCHORAGE TO FOUNDATION113 5/8'Anchor BolLsvimbedded or 5/8'Proprietary Mechanfcal-Anchors as an'alternative in concrete only Bolt Spacing-general................................ 4)..---- ---....---------------- in. _ Bolt Spacing from end(oint of plate........... :------...(Fg.� -= ------=-----•-=--_------ in.c 6"-12'. Bolt Embedment-koncrete_---------•----------__.(Fig 5)..__.__-_------...-_:--__ in.>-7* SDIt Embedment-masonry..---•--....__::_..--_--•:___----(Fig 5)---_=---=--------__---__-- Plate Washer..;_-.-:.-___-..---------------•-•(Fig 5)- >3'x 3`x Y.' 3.1 FLOORS Floorframing member spans chedcai :-----__.._._-. _._.(per 7B0 CMR Chapter 55)------__------------- Maxirrrrlm Floor Opening'Qfinertslori_-._..___ (Fig 6).__".__,----_-_--_--�• _ Full Height Wall Studs at Floor Openings less than 2'from Exterior Wall(Fig 6)------"...............•--..._..._..... Mbximun Floor Joist Setbacks Suppoitng Laadbearing Waifs or Shear wall___._.-__fig 7)-------_ ft 5 d Maximum Cantilevered Floor Joists . Supporting Loadbearing Walfs'or Sheanvall--------- 8)-------------------...---_�-__:_.._ft _<d FloorBracing at EndwafEs-- -- - _ ------ --(F9 -- Floor Sheathing Type _._..�.._---___---•- -_(per 780 CMR-Chapter 55)....:...... -:---------____-- Floor Sheathing Thidmess ._.-_____.__.-_..__ :_-(per78()GfJ[Rt;hapter 55j. � in. Floor Sheathing Fastening_....._......... ......__._r__.� (Table 2)_—d nails at in edge/_in field 4.1 MALLS- Wall Height Lnadbearing wads. '___-_-___-_ (Fig 10 and Table 5)------_- _--•_ft <1 D' Non-Laadbearing wafts-._--_":._-__•_-_-_'--(Fig 10 and Table 5)_-___..._----------_ ft-S20' Wall Stud Spacing _.._______.._..;---------____--(Fig 1D and Table 5) ___:..-___-_in.s 24`o-r- Wa4 Story Offsets- _--__-- ---- --- -..(Figs 7&8)----__-, ---- ---- ft c d 42 ED T, OR WALLS' Wood Studs Loadbeari�tg vra[!s�.__.__._..------••--..--_---- (Table )---:------------___.2x -_ft in. , Non-1_aardbearing•walls.-•-•---.----._._._..__ _...---.(Table 5)---_._-_".•".._.-.""_-2x --f in Gable End Waft Bracing t — Full Heid.ht Endwalf Studs-.----. _---•---..__.(Fig 1D)-:_•-------T---.-_--_--.._._.-_._V- WSP-Attic Floor Length------�. .__ --(Fl9 11)----.--------___- ft�tW/3. Gypsum Ceifing Length(if WSP not used)_. - Fig 11).-----.---- _-_-- _ft?0.9W _ and 2 x 4 Continuous Lateral Brace @ 6 ft o.c._(Fig 11�.............................. __ br 1 x 3 ceiTmg fun-ing strips @ 16'sparing min.vffh 2 x 4 blocking @ 4 ft spacing in end joist or truss bays DDrshle Top Plate Splice Length _----._.._:_�_._._.___.__--(Fig 13 and Table 6)__-________--_ ft - SpGrie EonneCf!Dh(no.of 15d r-DMMDn nails)_..._•.---_.(Table 6)_________.__----------------_ - 4iYC Gi de fo Wood Construction hi High ;lndAreas- IIO,rrxph HrixrdZone Massachusefffi Checklist for Compiiauce (780 CKR-50Ol 21;1 4. a. Frwn Table-10 and 11 and location of wall sheathing and B.urldmg,Aspect Rafio,determine Percent Full-Height Sheathing and►Mail Spacing requirements b. Wood Structural Panels shall be minimum thickness of 7116"and be irisfalled as follows- [. Panels shall be installed v6ft strength axis parallel to studs. I All horizontal joints shall occur over and be nailed to framing. rii_ On single story construction,panels shall be attached to bottom plates and top member of the double by plate- iv. On two story construction,upper panels shall be attached to the top member of the upper double top plate and to band joist at bottom of panel_Upper attachment of lowerpanel shall be made to band joist and lower attachment made to lowest plate at first fidor framing. v. Hor¢ontal nail spacing at double top plates, band joists, and girders shall be a double row of ad staggered at 3 inches on center per figures betow=Vertical and Horizontal"Nailing for Panel Attachment S. .Glazing protection_a)new house or horizontal addition—required if project is 1 mle.or closer to shore(generaDy,south of Rte.28 or north of.Rte.6) b)vertical addition—not required unless there is e>dansivd renovation to the first floor c)replacement windows-needs energy conservation compliance only(chap 93) S.Wood Frame Construction Manual(VJFCM)for i ID MPH,Exposure H may be obtained from the American Wood Council (AWC)website. W,4SRTMEDGEFEMDx i usE�r vas • 'ATHt.t ' Lj .1 11 1 n u •I . u [I i it V it LI JI r 1 Q = ll 11 K { 1 + I O ri J1 Ed i-i i l a - z t 1 : { CL i i t°a 1 It I1 t p l�r I 1 ! 1 i ll F )37Ea�� tl i L/. 1 . M. ii U D ii 1 V1 i i .It II OflsJ9z1= E t sTAGGEFED 3`RdY�L N41L YfITIH" � PRrirR 4 PAl EDGE DQUEtEMLEDG•.ESPACM DEIAT- Sea-Dalai!on Next Page Vertical and HE)rbM ribal NaTng Detail for Parcel Attachment VetMl gird HothmnW I airing for PaneI Affachmant . �TME Teti Town of Barnstable Regulatory Services vsaxrr i e� Richard V.Scali,Director ��ED �A1m 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 as Owner of the subject property hereby authorize I/v�,G�i�r to act on my behalf, i in all matters relative to work authorized by this building permit application for. Rio , 655-T (Address of Job) Pool fences and alarms are the responsibility of the applicant. Pools are not to be filled or utilized before fence is installed and all final inspections are performed and accepted. 01aAJ&ze�� Signature of Ownef Signature of Applicant Print Name in t Name Date Q TORM S:O W NERPERMIS S IONPOOLS i Town of Barnstable Regulatory Services 0 ��pFTxe rory,� Richard V.Scali,Director ' Building Division sAxxsrAstE� Tom Perry,Building Commissioner MAss. 1639- 200 Main Stet, Hyannis,MA 02601 QED MAI A re www.town.barnstable ma.us Office: 508-862-403 8 Fax: 508-790-6230 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-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,RuIes &ReguIations for Licensing Construction Supervisors,Section 2.1S) 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:\WPFILES\FORMS\building permit forms\EXPRESS.doc Revised 061313 1.i e� ............. .................... ................. ........ sk Iv011 71 tk LLL 4 q Tc a ��,� r; r , 1 IY�, r ask f r. --(19 • , r r ' I[ - .. -.... M, -.ar..... ....«..-.ef+...«�.....e�...oe..�...c..,.o.e.{...�...�.....a.<...,.�.+.., _ -..r..o...�..,:�.�+.,�.=.-R.�-.....�_....w...-....a.. - .....e,.�.->�.,....2..�s...— - 40 N 51Mp-COFN ec sla tk :b k ��_ i iq t f� i jMassachusetts -Department of Public S:..fety Board of Building Regulations and Standards :,.,. Construction Supenisor License: CS-047667 : 4 pBMLIP M VoLT PO BOX 64, COTUIT MA 02,9 l r. Expiration Commissioner _ 09/01/2015 Office of Consumer Affairs&Business Regula�on elf 1 SOME IMPROVEMENT CONTRACTOR egistration: .109558 xpiration:�.<_9/21/20.16:: Type: MARK Individual MARK VOLLMER 1455 SANTUIT WTOWN:RD' COTUIT, MA 02635 Undersecretary ±r F k :k r Y , y:n • or to: '•;1' re istration vale If found,returnse o License or g iration date. Business Regulation before th Con xpsumer Affairs And i p{fete'of laza-Suite 5170 t 10 PailK Boston,MA 0n16 i •l riot valid w ithout signature ;; Town 2- Town of Barnstable *P.ermit# � Expires 6 months from tissue date Regulatory Services Fee��:.�o� .�dr Thorce:�s F. Geller,Director Building DivL$iOn Tom ferry, CBO, Building Commissioner 200 Main Street,Hyannis,1%,1A 02601 www.torsn,l)ainstable.ma.us off-ce: 508-862-438 Fax: 50',-790- i230 F3.7R�E9 PES T APPLICATION - _ S.II_DEN..1AL_'ONLY Not Va,'sd without Red x Press Imprint m tip/parcel N-wnb r_ I mo" zpertyAddress_... .._ 27 Residential Value of Work Minimum fee of S25.00.for work under 00.00 Nmr'sName&Andress )ntraCb)I'$ ___.—Telephon.e Number_ ome Improvement Contractor License#(if applicable)_ ]V,roilc::izrnIs Compensation Insurance. X-PRESS PERMIT. Qi;.c.k one: V:i?,m a sole proprietor MAY 18 2007 I an the Homeowner Fj .I have Worker's Compensation Insurance TOWN' OF BARNSTABLE stuance Cornpany Name orkm :�'s Comte Policy opy of hsurance Compliance C'erbific.ate must be on file. ,Tmit Request(check box) ❑ Re-Ioof(stripping old shingles) All construction debris will be taken to� ❑Re-roof(not stripping..Going over .__existing layers of roof) � R side L] Replacement Windows/doors/sliders. U-Value (maxirTu .44) °WoeTe required: lssusnce of this permit does not exempt compliance with other town depa,-tment regu aM ons;i.e.Historic,Conservation,etc. ***Mote: Property Owner must sign Property Owner Letter of Permission; A copy of the Home Improvement Contrm.A ikunseA iGIeATURE: �-1Pk I Ca.I}� ,., Ry0.l. Forms:expmtrg ;vise061306 I " Town of Barnstable pp ZHE Tp� Regulatory Services BARNsrABLE, : Thomas F.Geiler,Director 9 MASS. g 1639• �.® Building Division lFn � Tom Perry,Building Commissioner 200 Main Street, Hyannis;1,iA 02601 Nvww.toWn.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HONIEWMNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: 10'400'L lY/LL D57 �-5�/LG� number street village "HOMEMAINTER": &2 4- �i /L�Gsy �p-`ILa k- P G(0 0 name �- home phone 4 work phone Y CURRENT MAILING ADDRESS:a�� 77&ef Z Q //L e- city/town state zip code The current exemption for"homeowners"was extended to include ov.,ner-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 HOMBOININER 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 home owner. 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-,NU comply with said procedures and re cements. Signature of Homeown 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. . HOMEOVV ER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt form the proN'Isions of this section(Section 1109.1.1 -Licensing of construction Supervisors);provided that if the homeowner engages a persons)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 oath 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 homeo-,vner 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. Ymi may care t amend and adopt such a form/certification for use in your community. Q:forTns:homeexempt The Commonwealth of Massachusetts Department of Industrial accidents Office of Investigations d 600 Washington Street Boston,MA 02111' www.mass.gov/dia ' fidavit: Builders/Contractors/Electridans/Plumbers Workers'Compensation][nsurallce Af A_pylicant Information Please Print Legibly Name(Business/Orgauizatiow7ndividual): .,4a Tl�U�' 2Gt/� Address: a 7a'w�2 �, City/State/Zip: dci sZv//LG�r /} Phonet 509 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 hued the sub-contractors 7. Remode 6• ❑New construction . 'employees (full and/or part time).* 219 I am a'sole proprietor or partner- listed on the'attached sheet. ❑ � ship and have no employees These sub-contractors have g• Demolition working for me in any capacity. employee$ and have workers 9• ❑Building addition [No workers' comp•insurance comp, insurance. 10. Electricalr airs or additions 5. ❑ We are a corporation and its ❑ 3.[�Iequired.] officers have exercised their l l.[]Plumbing repairs or additions ' am a homeowner doing till work . myself.[No workers'comp. right 6f exemption per MGL 12.0 Roof repairs insurance.required.]t c. 152, §1(4),and we have no 13 ❑.Other employees. [No workers comp•insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy infamnation• t Homeowners.who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those aides have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. ensation insurance for my employees. Below is.thepolicy and job site' I am an employer that is providing workers'comp 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). Failme.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 Investi ations of the DIA for insurance coverage verification. 7 do hereby c rtify under the pains•and penalties of perjury that the information provided above is true an'd correct Si tore: Date: Phone#: Official use only. Do not write in this area, to.be completed by,city or town official City or Town: . .Permit/License# Issuing Authority(circle one): :1.Board of Health 2.Building Department 3. City/Town Clerk 4.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 hiie, 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•complianee with:6e insurance requirements of this chapter have been presentedto 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-conti•actor(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 Towti 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 maybe 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 IDqpartmimt of Industrial A ccid is Offii ce of luvest3gat ous 600 Washingtomi Stmd Boston-,.MA 02111 Tel.#f 17-727-000 ext 406 or 1-87 MASSAFE Revised 11-22-06 Fax#617-727"7749 WWW. tas&gOV/dia TIM The Town of Barnstable NAM tee$ Department of Health Safety and Environmental Services 1"16Eor1' Building Division 367 Main SftM Hyannis MA 02601 Office: 509-790-6227 Ralph Crosses Fax: 308-7904MO BuiIding Commission! For office use only Permit no. Date AFFIDAVIT i HOME IMPROVEMENTCONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the "reconstruction, alterations, renovation, repair, moderni=don. conversion, improvement, removal, demolition, or construction of an addition to any pre-existing owner occupied building containing at least_one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors, with certain exceptions,along with other requirements. Type of Work• ' Est.Cost &OV-6 Address of Work: //d�� 05� i___i/LQ ^ • Owner's Name 6-A� Date of Permit Application: — I hereby certify that: Registration is not required for the following renson(s): Work excluded by law Job under SI,000. BuiIding 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. I-Id Da Contractor Name Registration No. OR Date Owners Name L a The Commonwealth of Massachusetts Zi 1 `� =_. Department of Industrial Accidents Office of1fiYesti0atiaas - = 600 Washington Street ,+r Boston,Mass., 02111 Workers' CoTyensation Innssuranc((/ee Affidavit oI-KAZir r„ C�II t name: location: city ) 428 224� phone a ❑ I am a homeowner performing all work myself. ❑ I am a sole proprietor and have no one working iri auy ca actty „ //% I am an employe$��� 1 for my employees working on this job. cotnpanv name 71 TARAGON CAR address: COTUIT MA 02635, •� � .. city (508) 428-2292 „hone#: insurance co. _ mlicV# ° Q %//////////////////////////%/////.%/////%/////////////%/////////%/////////%////////////%////%//////%/%//%//%%%//////////////////%////%%/////////// ❑ I am a sole proprietor,gene contractor, or homeowner(circle one)and have hired the contractors listed below who have the following workers' compensation polices: ........ com any name: address: hone#: d :.. insurnnce cn :..;.. niicv com anv name: address: dtv hone#. ::.:... If insurance•co. �ill // Failure to secure coverage as required under Section 25A of.%IGL 152 can lead to the imposition of criminal penalties of a One up to S 1,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a One of S100.00 a day against me. I understand that a copy of this statement may be forwarded to the Oidce of Investigations of the DIA for coverage verification. I do hereby c r the p d penalties of perjury that the information provided above is true and correct Signs.lure (�� � Date Print nalne pac yn C _Phone# official use only do not write in this area to be completed by city or town ofticiai city or town: pertait/license is ❑Building Department ❑Licensing Board ❑Selectmen's Office ❑che—&f immediate response is required. ❑Health Department Outer contact person: phone#: ❑ ([mud 9/95 P1A) L I _ Information and Instructions , apter 152 section 25 requires all employers to provide workers' compensation f Massachusetts General Laws ch or their ,law,,, an employee is defined as every person in the service of another under any cotitrac employees. As quoted from the of hire, express or implied, oral or written. An employer is defined as an individual, Partnership, association, corporation or other legal lentitv,,-or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives,of a�d#ec eased employer, or the receiver . trustee of an individual, partnership, association or other legal entity, employing`emplbvees..'Howe�er the owner of a dwelling house having not more than three apartments and who resides therein; or theoccupantkoft the dwelling house of another who employs persons-to do maintenance , construction or repair work on such dwelling house or on the grounds o: building appurtenant thereto shall not because of such employment be deeiiicu�., U. .UL r J--• � �_1. , . . i. MGL chapter 152 section 25 also states that every state or local licensing+agency shall-withhold the issuance or renew of a license or permit to operate a business or to construct buildings in the commonwealth,for any applicant who ha not produced acceptable evidence of compliance with the insurance coverage required: Additionally,neither the commonwealth nor anv 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'ehapierhave been presented to the contracting authority. Applicants ' Please fill in the workers' compensation affidavit completely, by checking the box that applies to your davits�v be and supplying company dames, address and phone numbers along with a certificate of insurance s all 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 stri o ther cense w"oris you being requested, not the Department of Ind ual Accidents. Should you have any questions regarding policy, please call the Department at the number listed below. are required to obtain a workers' compensation City or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space atb P ease f the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. be sure to fill in the permit/license number which will number. The affidavits may be returned fo the Department by mail or FAX unless other arrangements have been made d like to thank you in advance for you cooperation and should you have any questions. The Office of Investigations woul please do not hesitate to give us a call. ////�//////m/// FENII The Department's address,telephone and fax number. The Commonwealth Of Massachusetts Department of Industrial Accidents oMce of lmlestigadons 600 Washington Street Boston, Ma. 02111 ; fax#: (617) 727-7749 ate.° " phone #: (617) 727-4900 eat. 406, 409 or 375 , I ^ _ , .+_ •. .b4'ed�LrKiM� r.YA!}'- YY1 r• �:+ � ,;y, 4 N. A •i% 't . ,' ra i ,..F "aCvrlS �� `•S - i. .r i ,e�,:'. �.ry }. K � � .5: j � �r,� 'i _+fir: ,�.r �� j Y . �� �� •� .. � '�'' 'x.�,l ,, � .+aa � --+ ,4 • of L{ jw M��•�� �//� '(n4 $ t - �1 Y( yy_s e1. Y Y �.,r �,S�, -�'Y' tni tf y C r t � i 4t'�7 ✓ jv a ' '[r�Y�• str ! i iyt4 -X-'.�4yre' ^"1.n } it , Fa Et' )l• � x'n tuft t v t,�•1!•. t- .Jt,1 t -�.r �y `. •�3 ,•"� L� '� +•yyJ"3 d'S -.h ..,�r 'stir,r"'��Y,�4,ath Y� i4+�1Qf "fv .�.s�.d4i+ t Ty+ !� its'y 4 r ; +�''•' _'1". r + i4>:' ,�r, -trf.:w ,• 1$ .u• i' ..fir,. �a C've .r t�F kW/'� •-c L.r+1•s ArF- �+ Y•n �r r 1. �. 'REGISTRATION r ,.`CONTRACTORS.: ?.¢ ,+ � ?�;�� r, , ?�3� t •� � ,', OVEMEN di fiF ' t,+r , t HOME, a ulationsYand'- Standar! T r m , .,' rLr , ► . BOar d i Id i nd R69 r. F t r ± r Y.tk YC7 Yi �t ♦¢4', �v� }r, [r Y', Ft S N'/ ••of.. Bu z 1301, } ^� x ��ss Ashb 'Place:.- Room ,( ��nri a � � rya s rye Ones Grtc�n 4 o210sJ6 .r4�r.• t x M ssachusetts, �,, A-V ¢•r? BOSt On s ! jEr pr rr+t 'iv1 t�.+f•q ft• wts wf)�° w y yi i 1� M 4 ��--••--`.F`�.�1N tHt ��(+�l,f���.11 3 Ka..".;:1' -,' YS _ yr♦�,(F.� -•r• ` a� .r..c..'`` ^5 ytaAY C�.13•• T' -•1 .\ t. ,•CONTRA 1 OR } "'• �: , ;, _� > ` IMPROVEMENT..: "''�`tifr3,r ra:» 4 ;Expiration y04/06/99• ,; �+eL.•� N1.12536 ;r � r< .,.a � .<z Kix .tration,, .� r + �. ;' ,.x 3 Sg st tr s • sly;,¢ c..F y y �'tNOME'INPROVENENT,CONTRACTOR [' .M R✓ tl' S r„ r yt i'1 +'!'tt +'. I.k'" •1`S 1il ''• n ,y, ,+ra�•��b tQb Y ,ti`.AtR 1 A c!}a y.�, ��i }�fs�4. 4�l? i1 i!'c�r` �+NV 'y Y + ate.`1 r �"'112536 ' %"'r •+:`i 4-, �,. l2.* ?'F�,k � •}•4:. f;kt�.r*+ ;i4 .�%•k)) +•f '{»,+-V`s• ,._', , "', t�rr .'Registfati00�t ,s:wt, + ,Yr : �" 7 ; ' Lw +r'I ate..,,7' ` •:, , , f'•.. . �. x�.�` ,v�a�x.� `+1;.;;� r.� e�"� �"'.�`� ,•s:�+�.�� :x ,,�rr� ,,,.r�, s' �� � rrTyPe��DBA��'� �• ��" ,` '-`� ti j Exp Tation 04/06/,99�,__- . ' ERASER UCTIo {, MCONSTR . ; `# 't .'" �' '' 1 Y ,�..� ,,C_ .`FRASER,� .n .�..� a 9! tk �x x is DEAN' �r. > aft`f � � � < �!��V. , a r ,;., Rf`,�y , Sri;l c 4 h i,s y;`q F � ; M ► %. »ns FRASER;CONSTRUCTIOW 71. TARRAGON CI �, .� _ zk q= { 5 ,A1K �,.,+s >/ tiY iTN�h C'"FRASER V02635' CO TUIT MA 1'TARRAGON Cl R ix r ,•. ,Y. .3 rr•t •���•• y �+ ����"rtl. t�,}�`ir A� , zr^E+,f-�rrY �,+�Ww �$ZppTORf"� �t' v� t� ;�+ +� j x+ry 1 !k+ ty�` .,tPra i F v !I a.Yr••'t +kh 4S+ e 'i r , ,. l• +- tR j ^ +�r t+ ';5• t�. a 1:�•, ins, .+r.'ti.� '; �' ,�,,, ,,;5 ti ;r,,s -COTUIT;MA+02635 S•S�F7`e�}'x:„j.l�r ''L + { �• "i T.ti-.— •� ,t. �. .�:.a,�.... RE-ROOFING If located in OKH or Hyannis Historic District-Certificate of Appropriateness required unless same color/same materials specified on application / Map/parcel number Sip-offs from Tax Collector /#of squares of shingles or square footage of roof to be shingled �pecify stripping old shingles or going over old roof. If going over how many roof layers existing now what size are rafters? What is span? _ Complete dwelling information for the/Assessor's Dept.-if known /Wo kkkerman's Comp. form ,,/Home Improvement Contractor Affidavit(RESIDENTIAL ONLY) (/ 'Jome Improvement Contractor's License �/ OR Homeowner's License Exemption(RESIDENTIAL ONLY) heck expiration date on license COMMERCIAL WORK-No License is required. vFee . q-forms-PERMITS I Rev 6J2/98 ..Engineering Dept. (3rd floor) Map o Parcel Permit# 32. House#_ - '' Date Issued Board of Health(3rd floor)(8:15 -9:30/1:00-4.30) Fee ;?.5 1) - �^ Conservation Office(4th floor)(8:30-9:30/1:00-2:00) Planning Dept.(1st floor/School Admin. Bldg.) 1►� Definitive Plan Approved by Planning Board 19 - BARNMBLE. V`. MASS. TOWN OF BARNSTABLE Building Permit Application / Project Street Address <9 6 Village -,-en l91 (Y)A , Owner ct/L" Address Telephone n `•Permit Request lu -First Floor o� 0,P5(square feet Second Floor square feet Construction Type ' Estimated Project Cost $ b—cryo --- Zoning District Flood Plain Water Protection Lot Size Grandfathered ❑Yes ❑No Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House ❑Yes ❑No On Old King's Highway ❑Yes ❑No Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: Existing New Half: Existing New No.of Bedrooms: Existing New Total Room Count(not including baths): Existing New First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil ❑Electric ❑Other Central Air ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove ❑Yes ❑No Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) ❑Attached(size) ❑Barn(size) ❑None ❑Shed(size) ❑Other(size) a Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# Current Use Proposed Use FRASER CONSTRUCTION Builder Information Name Telephone Number Address GOTt IT MA 02635 License# (508) 428-2292 Home Improvement Contractor# 16 Worker's Compensation# 36w0 I'7 NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO _t SIGNATURE DATE BUILDING PERMIT DENIE I FO b'jF FOLLOWING REASON(S) FOR OFFICIAL USE ONLY rJ PERMIT NO. G 233 DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE w4 -1 OWNER o Yi,a cae• DATE OF-INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. F.-7' Assessor's map and lot number 0* roe THE Sewage Permit number ... 2le...... .. ..... . House number ...... EARNSTLBLE, 1:44.9.................;? ................ ,NNWMM TOWN OF BARNS N RGU `Eb qND L CODE L4TIONS BUILDING INSPECTOR APPLICATION FOR PERMIT TO .............................................. TYPEOF CONSTRUCTION ..................................................................................................................................... ................ ................ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for .a permit according to the following information: v Location ............................... Q ........................................................................ Proposed Use . ....................................................................... 06x�,\-�' ................. ZoningDistrict ...:....................................................................Fire District .... *.o............................................................ Name of Owner 14....................ee....4. �K....Address V... J.................................... Name of Builder ...\N\k........Address ......L ,4.& Nameof Architect ....... ..tvN .:....................................Address ..................................................................................... Number of Rooms ....... .................................Foundation .....(ra..k..0................ ...............................;........ Exterior ....V_1g:N%n-A.....................................;........................Roofing .....4tp&k\��- ...................................................... Floors .....120,r�I ............................................................Interior .... U-I ImA\..................................................... Heating Plumbing ......fN)..0................................................................. ... Fireplace ......I--V. ..................................................................Approximate Cost ..... ....................................... Definitive Plan Approved by Planning Board ------------------------------- Area ...140............................... Diagram of Lot and Building with Dimensions Fee .... .............. ................. SUBJECT TO APPROVAL OF BOARD OF HEALTH ptv------- I hereby agree to conform to all Le Ae and Regulations of the Town of Barnstable regarding the above construction. ....444.00?, Maruey, Arthur u. - � 21800 add to frame No -- .. Pe,mh for ........ ..----.. » � dwelling .. .................................... � 8�llBuad Lpcononr ---------------------. Ootarvillm --------------------------' Arthur K. Maruey Owner ---------------------- � frame ' Typo of Construction -------------- ............................................................ ................... ^ p .............................Plot Lot ----------' | ~� { . . � ~ Permk'G,on�uJ ---� .. ---]g ?Q 2g Date of | -----� lV � ' . . - Dote Completed ................... ^ � ` ` � . . ' ^ PERMIT REFUSED ' ^ - . lP . ........................................... -- ......................... ' | ^ | ----' . ��. ! ..___.. - � | to 0 �� lg Approved , J�8o" _. -----.. .......................................... ' -------'-----------.—~....—~—. �� ��� r Assessor's map and lot number THE 1 Sewage Permit number .... ..!....':...:1 .� -' ' .:... d� o� ............ ...... / j Z BARNSTABLE, i 1/ :%67�( ( Mae& House number ......-.. .............._...................... 'ov 039. �e TOWN OF ' BARNST-ABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO ��-� � `'� I .N ti............................................................................................................................. TYPEOF CONSTRUCTION ..................................................................................................................................... ................................................. 19..7-4 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: 7�ht,Jr Hit ,- � Location ..................................................................................................................................:.................................................... .Proposed Use ....ry. ..\at.........................................................r.1......� .................................................................................. . Zoning District ....��.. ".........................................................Fire District o� .............................................................................. Name of Owner .............................................................�-�,�ir /f , ....Address . G ... G ... f`G.... - Name of Builder .1\..,..:r- ...v..111*... .... •� � *.........Address ....................'mot ., .. ... ...................................... Nameof Architect ........................................Address .................................................................. f � Number of Rooms ........1.................................Foundation ..... ....:`......:........................................................ �. Roofing �'�. � — Exierior ............................................................................ ............. ...................................................................... Floors ............................................Interior .... :.` ,e,. +� Heating .....:............................................................................Plumbing .................................................................................. Fireplace ..:...... Approximate 1- - -....................................:.................................... Cost "............................................ Definitive Plan Approved by Planning Board -----------_____----------- _______. Area Diagram of Lot and Building with Dimensions._,-- Fee �. Id SUBJECT TO APPROVAL OF BOARD OF HEALTH I 1 - +. 1 r e, I -- i I hereby agree to conform to all the Rules.a_nd Regulations of the Town of Barnstable regarding the above construction. -� Name .�A....... . .......... ..............::............... ........ � � '_-'_, ' Arthur ..� A 1`=~`1 ^ � 21800 add to . � No -----.. Permit for --------..--- . / ` ' dwolIi ! ------� ' -------' ~� . ' ' �- Hill Road ' > Location ---1�����----------.�'�' ' OotervilIe --------------------------. ` ` �rtbur � Owner ---. . . - . ..^ ""=^^��................... of Con / ' Type ' ' '~ � / ^ ~ - Permit Granted ' ~~'~ of Inspection^ , Date Completed � - � ` PERMIT~ ' ----.. 9 . ' ,---- -1. . .................... ` \ \ , � \ �'---' ---'4r------'/------- \ � i � .� ` ` �-----..�........................................................... '-------~------'''--~--^---^-' / ' / . � -.�--------------.. l� Approved / -'''------'-------^^^-----^-'-- [ , . ^------'—`----------~...--~... . ^ | '