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Home My WebLink About0102 WEST BAY ROAD ,5Z � q Town of Barnstable * p C Io so( y0 Expires 6 months from issue date s a Regulatory Services Feedf a s 9 amass Thomas F. Geiler,Director U�1 z41�� Building Division Tom Perry, CBO, Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.bamstable.ma.us Office: 50.8-862-403 8 Fax: 508-790-623 0 EXPRESS PERMIT'APPLICATION - RESIDENTIAL ONLY Not Valid witliout Red X-Press Imprint Map/parcel Number 3 Y� Prope Address /) �,��Z';7 / i '�_'` t t 1 ��'�/7Ly/�p p �j T Residential Value of Work '�l�� Minimum fee.of$35.00 for work under$6000.00 Owner's Name&Address Contractor's Name �(' �- Telephone Number X C lz 1 77k, Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) d 3 ❑Workman's Compensation Insurance Check one: �-P ❑ I pn sole proprietor OBI am the Homeowner !`t�iVVtei OF BARNS TA-1 ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's Comp, Policy# Copy of Insurance Compliance Certificate must accompany each permit. 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) ;Zeplacement -side #of doors Windows/doors/sliders. U-Value . (maximum .44)#of windows. *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. A copy of the Home Improvement Contractors License& Construction Supervisors License is required. SIGNATURE: Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc Revised 070110 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/OrganizaationdndMdual): Address: F City/State/Zip: ,(� Phone#: Are you an employer?Check the appropriate bog. Type of project(required): . 1.❑ I am a employer with 4. am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 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 working for me in any capacity. employees and have workers' [No workers' comp.insurance comp, ins„ ce.t 9. ❑Building addition required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doingall work officers have exercised their 11.[-IPlumbing 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' 13.0 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. 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: Policy#or Self-ins.Lie.#: 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 under the pains and penalties of perjury that the information provided abov is true and correct. Signature: / 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#: I •� 4.: 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 Le 'bl Name (Business/Organization/Individual): Address: City/State/Zip: , gone #: 1-776 Are you an employer? Check the appropriate box: 06 Type of project(required : 1.❑ I am a employer with 4. El I am a general contractor and I Veloyees (full and/or part-time).* have hired the sub-contractors 6• ❑New construction 2. a sole proprietor or partner- listed on the attached sheet. 7. a4remodeling ship and have no employees These sub-contractors have 8. Demolition working for me in any capacity. employees and have workers' [No workers' comp. insurance comp.insurance. 9. ❑Building addition required.] 5. We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doingall work officers have exercised their 11.[l 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. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Belo he policy and job 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 aration page(showing the policy number and expiration date). Failure to secure coverage as required under Sec ' 5A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year impri ent, 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 vi or. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for in ance coverage verification. I do hereby certify under the pains nalties of perjury that the information provided above is true and correct. Signafore: Date: l Phone#: Q 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#: �t„E r Town of Barnstable Regulatory Services 'BnaDrsTaBLE, ► Thomas F.Geiler,Director 9�A 13 9. •�� 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 HOMEOWNER LICENSE EXEMPTION �g Please Print DATE: S,�,pV I S,cV I/ JOB LOCATION: G �( - �/U�o number street village "HOMEOWNER": NN` Tph .e name home # work phone# CURRENT MAILING ADDRESS: / K 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. 9 Signature dfAomeowher 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 �THE'�wti Town of Barnstable Regulatory Services BARNSresus, �89 g Thomas F. Geiler,Director s639. �0 o n+Ay& Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 568-862-403 8 Fax: 508-790-623 0 Property Owner Complete and(Sign T Section If Us in A B er as Owner of the subject property hereby authorize &je.-t to act on my behalf, in all'matters relative to work auth ed b this building permit Qz, (2(t (Addy s of Jo **Pool fences and alarms re the responsib' ' of the applicant. Pools are not to be filled before ence is installed and p is are not to be utilized until all final ins ections are performed an ccepted. Signature o Owner Signature igna of Applicant � h T . 6tVL4 Print Name Print Name Date \ Q:FORM&O W NERPERMISSIONPOOLS t 1 r co l � z `� own of Barnstable *Permit' ppTHE`Tp . P� Etpires 6 ` nths Jrenrtssue date Regulatory Services Fee srwste, Ql V, ` A ' Thomas F. Geiler,Director Building Division Tom Perry, CBO, Building Commissioner 200 Main Street, Hyannis, MA 02601 - www.town.barnstable.ma.us Office: 508-862-403 8 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY 'J - Not Valid with out Red X-Press Imprint ' Map/parcel Number ' 1 ( . -Property Address• o (A)<?f7j ❑Residential Value of Work ` �.0 Minimum fee of$35.00 for work under$6000.00 Owner's Name &Address m MAILL +- �i�✓� �'�-t �� Contractor's Name r'�� r Telephone Number 6 z 7` Home.Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) e ❑Workman's Compensation InsuranceT� - Check one: I am a sole proprietor fff I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's Comp. Policy# Copy of Insurance Compliance Certificate must accompany each permit. 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) e-side #of doors ❑ Replacement Windows/doors/sliders. U-Value (maximum .44)#of windows *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. A copy of the Home Improvement Contractors License & Construction Supervisors License is required.9` SIGNATURE: Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc Revised-0701 10 The Commonwealth of Massachusetts Department oflndustrialAccidents Office of Investigations 600 Washington Street Boston, MA 02111 www.m ass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Elee'tricians/Plumbers Applicant Information / Please Print Legibly Name(Business/Organization/Individual): IJA6 f/l.() rY1.Gf Address: �� City/State/Zip: (�S �PiI�VI � /1� �Z Phone.#: UrOS- Are you an employer? Check the appropriate b x: Type of prof ect(required): 1.El I am a employer with 4. JAI am a general contractor and I employees (full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or'partner-- listed on the attached sheet T. ❑Remodeling ship and have no employees These sub-contractors have g• '❑Demolition working for me in any capacity. employees and have workers' 9. ❑Building addition [No workers'•comp.-insurance comp. insurance.$ required.) S. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.El 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 lZG 5I�J,Lk-Q 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-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must providb their workers'comp.policy number. Iam 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 crimiria.l penalties of a fine tip to S 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 under the pains and penalties of perjury that the information provided above is true and correct. Si ature: '� 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 S.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." I An employer is defined as"an individual,partnersbip, 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 Rzth 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 pernit/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" (.he 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, telepbone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents office of Investigations• 600 Washington Street Boston, MA 02111 Tel. # 617-727-490.0 ext 406 or 1-877-MASSAFE Fax# 617-72777749 Revised 11-22-06 www.mass.gov/dia 1 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, AM 02111 r- www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please.Print Legibly t_ �j P L Name (Business/Organization/Individual): / ��V �J. V� 6-A�AJ Off-I) /06 67_ /`d-- City/State/Zip: ��7J� f 1�G/5 �6� one #: '7� Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with ��❑ I am a general contractor and I 6. ❑New construction VI ployees(full and/or part-time).* have hired the sub-contractors ' 2. m a sole proprietor or partner- listed on the attached sheet. ❑ 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 homeowner doing all work right of exemption per MGL 1 LE] 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. ther Lj 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. IContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp,policy information. I am an employer that isproviding workers'compensation insurance for my employees. Below is thepolicy and job 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 to 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 under the pains and enalties of perjury that the information provided above is true and correct �tSi itu 7e==,- c--Date: cPho#y n 9 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 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 occupantfof 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 o applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §2-5C(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 r 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 certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is-required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would 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: o The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations' 600 Washington Stt•eet Boston,.MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Revised 5-26-05 Fax # 617-727-7749 www_n�ass.gov/dia h i Town of Barnstable IHiE Jp�y o Regulatory Services t akarrsz.ASEF- : Thomas F. Geiler,Director at i ac ' Building Division �PrfD HAA{► Tom Perry,Building Commissioner 200 Mairi•5treet,_Ayannis, MA,02601 www.to wn.b arnstabl e.ma.us a Office: 508-862-403 8 Fax. 508-790-6230 HOMEOWNER LTCFNSE EXEKMON Please Print CDA7E: L — � oZU� t too- JOB=IACAT70N-, numli I,, �^. ircct � village YHOMEOWNER" /�� `:1Z i yWlJ1) F �l zJ �17 a0 7� name [ home phone# work phone# eityhown 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. DEFI=ON OF HOMEOWNER Person(s)who owns a parcel of land on which be/sbe resides or intends to reside, on which.thcre is, or is intended to- be, a one or two-family dwelling, attached or detached structures accessory to such use and/or farm structares. A person who constrgets 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 be/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 B1rilding Code and other applicable codes, bylaws,rules and regulations. The undcrsigned'bomeowner"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.' 'CSignatisi-c o0 otncmvncr `-- °Approval-ofBuilding:Offhcial- Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Scction 127.0 Construction Control. HOMEOWNER'S Exy-mmON The Code states that: "Any homeowner pc fonming worm for which a building permit is required shaD be exempt from the provisions of this scc6gn_(Scc6an 109.1.1 -Licensing of construction Supervisors);proyidcd that if the homcotvocr rngnges a pe-son(s)for birc to do such work,that such Homeowner shall act as supervisor." lriany homeowners who use this exemption arc unaware that they art assuming the responsibilities of a supervisor(scc Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Scction 2.15) This lack of zwa=css often results in serious problans,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 ultimatc)y responsible. To ensure that the homeowner is fully aware of his/hcr iuponsibilitics,many communities require,as part of the permit application, that the homcowna certify that hdsbe 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 fom>/certifieation for use in your community. i trti Town of Barnstable ` Regulatory Services sr.E$ Thomas F. Geiler,Director 4'�Fo }�� Building Division a 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 IfUsing ABuilder as Owner of the subject•property hereby authorize to act on my behalf, is all matters relative to work orize this building permit application for. Address of job) ;¢. 7 Signature of Owner. Da Print Name If Property Owner is applying for pern it please complete. the Homeowners License Exemption Form on :the reverse side. s TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel Permit# °7820Z. Health Division 412 'q ;la ( I: pARNSTAgLEDate Issued Conservation Division y�� f-2/0-3 , Application Fee c Uy ?11� JUL 12 'A9 8 56 h o c,v Tax Collector Permit Fee Treasurer -y- Q iVISION 7SEMC SYSTEM MUST BE Planning Dept. II STALLED IN COMPLIANCE Date Definitive Plan Approved by Planning Board MTf+TITLE 5 Historic-OKH Preservation/Hyannis Project Street Address /; 4s4( r2clAd . Village _ 6 ,S&— t ()r` 1/ eel e-yW e ✓!� a ti N, fie%►-ion�� Owner I A ��p,�- a�� 7 Address 106) _ 141Tu�y �a/AGP . Telephone &/7 — 2/a 710 d Permit Request & /1+A./ t:1 CIO TO /'Zap-1 0/7'( -1 c� Square feet: 1st floor: existing G U proposed �2nd floor: existing /2d3 proposed _� Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 5--7 ua c-1 Construction Type Aaf>,`G ,7!27'e,-q j Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes ❑No On Old King's Highway: ❑Yes ❑No Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new Half:existing / new Number of Bedrooms: existing new Total Room Count(not including baths): existing new � First Floor Room Count lJ Heat Type and Fuel: lamas ❑Oil ❑ Electric Cl Other Central Air: ❑Yes alq_o Fireplaces: Existing New_� Existing wood/coal stove: ❑Yes Q1101- Detached garage:❑existing ❑new size Pool: xisting ❑new size Barn:❑existing ❑new size Attached garage:❑existing ❑new size �_ Shed: ng ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded El Commercial ❑Yes Flo If yes, site plan review# Current Use r �U Proposed Use BUILDER INFORMATION Name I�P�I�� n NNj-e Telephone Number 1�0a— Address NZ-7 C16 99- 1 ri,ACJ, License# C S d 16j Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO L SIGNATURE DATE 12 4 FOR OFFICIAL USE ONLY PERM1-T NO. _ DAT NSUED MAP/PARCEL-NO. 3 ADDRESS VILLAGE OWNER r. DATE OF INSPECTION: FOUNDATION FRAME INSULATION = 'Y FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH a FINAL , FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. f , oFt�e ra,, Town of Barnstable i Regulatory Services • IA ffrABLE. ' Thomas F.Geiler,Director KAM 9`bA,E 039. & Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. Type of Work: N��-C. /�/ �_Estimated -7UG G Cost i I Address of Work: �(, C P % /�, /n d, V``7�'�l U�� l.(�' �'�,��TOc)6j5 . Owner's Name: Date of Application: e20 I hereby certify that: Registration is not required for the following reason(s): ork excluded by law ❑Job Under$1,000 []Building not owner-occupied ❑Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: —71, -� /0 0��- C 6e5_15 Da a Contractor Name Registration No. OR Date Owner's Name Q:for=:hon=ffidav L The Commonwealth of Massachusetts Department of Industrial Accidents WCO sthM"909M 660 Washington Street Boston,Mass. 02111 . Workers', Com ensation.Insurance Affidavit-General Businesses sa'- a_ r , �'s?t'va.//�'1Td• fir' ra /\ "•' '°''.. �••.�i_ �— .SniU] - . Warne address G -- V 1A-t'�j�CINL • �llS state / ziy' � �� yhono# 7VU ^7'�� tiozi full address : D W�� _ pa� -rit(�r` T Y work si loca am•a sole proprietor and have no one Business Type: [] etail❑Restaurant%Bai/Eating Establishment working in any capacity. ❑Office❑ Sales(mcluding.Rtal Estate,Autos etc.) ❑I am an em to er with •etn�lo es full& art time. ❑ Other ' �I am an wip yer providing workers' compensation form oyees working on this job. ��: :.iJ t;,It:s? .. .t. p'. !;s.' 'ti' . . �•' :`t: �'i�X''>'• '�* 1'' y. .•J. : .l �.. ,.t . Ad$re'ss el: 1•,.•'•.::'.'. :.• .:r• JSi.:4, J.,it. -.:•.,i'Vn%tr..k:'.. OLL� •#�� .} :t • .J---r---e.cn ' / . .. . J I am a sole proprietor and have hired the in contractors listed below who have the following workers' compensation polices: :'s; ;ar,7' t,t. I�-• •}:�..:.,. _c' F. ,i> L''t ..11i� .-Y`; :.+h,.J:•, :is:':a i'^:'= �� 'IIfllIIe: 'r•• .• e en :y;... 1•.x.i: :'.l.::fr�'�'`t:' 'f•.:•' ... .. ,'.y:J:.'!�:.:.;. .r .f•,.` .. .. ♦Y• Ji' - .:� ir.�Y• �.:�:4 i';. .i tip: 1' - �•P�'� _�•� p:s: ,V� .'c''.�:!•v r,i;:' . .•t"�• .I'.'w:I,IS`� '�,::Y:•�::' s,' '�r�•. - Z.`,•:M1:;C.' _ "•'yt' •:i% o: i;:.ir:•N. `.P.' ;,2Z•y .%�'•;'�� -i• �•O-11C :tt••. ^.•)�':2•r:..:;Y•.i'• �•`s..` i.•.�' sur'ance co. �'t�. �i.:"'' .i;. _ •.� `�,`. ,.fir.*;:0. ? :s:�i;::;�,'•: ;., 't:, �t�.:�� :.�::r ,+fir'. :'i,�r;.,.,;' •ti. :•,-:,.�e.' essc. � •� ' '"Li:•v. ': :-?' � i%:.- .:;�'�.:�.ti%• _ .`:is•..'•i. tii.' - .::• fnsiirsace cb: Do lex. , ol� �� Failure to secure coverage as required under section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one years'imprisonment as well as civil penalties In the foim of a STOP WORK OitDER and a fine of$100.00 a day against me. I understand that ti ded to the Office of Investigations of the DIA for coverage verification. copy of this statement may be forwar I do hereby certify under the pains and ties!try that the information provided above is true and correct Signature . . Date Print name ' P) �1 C� Phone# I . official use only do not write in this area to be completed by city or town official city or town: permitllicense# ❑Building Department . ❑Licensing Board ❑,checkif immediate response is required ❑Selectmen's Office ❑Health Department contact person: phone#; Other (revised Sept 2003) Information and Instructions. Massachusetts CeT�Lam chf pter�152 section 25 requires all employers to provide workers' compensation for their. employees.. As quoted from.the"law", an employee is.defined as every person in the service of another under any contract of hire; express or implied; oral or written. An employer is defined as an individual,partnership, association, corporation or other legal entity, or any two or mare 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- s to do.maintenance, construction or repair work on such dwelling house or on the grounds or another who employs person building appurtenant thereto shall not because of such.employment.be deemed to be an employer..:. MGL chapter 152 section 25 also'states that every state'or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the.cOmmonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required Additionally,neither the commonwealth nor.any.of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting . authority. Applicants Please fill in the workers'compensation affidavit completely,by checking the box that applies to your situation..Please supply company'name, address and phone numbers along with a certificate of insurance as all affidavits maybe 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 Accideuts. Should you have any questions regarding'the"law'or if you are required to obtain a;workers'•compensationpolicy,please call the Department at the number'listed._below. OWN, on:2 City.or Towns . Please be sure that the affidavit is complete andprinted 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. The.affidavits.may.be.returned to the Department b}�ri>ad or FAX unless othei arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have aby 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 Dino of Wesfttlons 600 Washington Street ' Boston,Ma. 02111 fax#: (617)727-7749 phone#: (617) 7274900 ext:406 Town of Barnstable p�SHE Tph� - Regulatory Services Thomas F.Geller,Director '�i� i639 A•� Building Division ATED tM� Tom Perry, Building Commissioner 200 Main Street, fiyannis,MA 02601 . v.town.b arnstable.ma.us Fax: 508-790-6230 Office: 508-862-4038 Property Owner ust °Co-fq -ete and Sign This Section. a - =If Using A Builder lNN ,as Owner of the subject property to act on my,behalf, hereby authorize - =natters relative to work authorized by this building permit application for; in all . (Address of Jo a 4t4LSignature of Owner . r � � �I VnA VY— V—„ Print Name K9 AAA 0 I . Qo�J S. /C;? `l 07/12/04 TOWN OF BARNSTABLE PAGE 1 REVENUE COLLECTIONS PERMIT TYPE TITLE TOTAL GASC GAS COMMERCIAL 90.00 GASR GAS - RESIDENTIAL 25.00 MISC MISC•WIRING FEES 60.00 PLUMC PLUMBING INSTALLATION 705.00 PLUMR PLUMBING INSTALLATION 122.00 TOTAL REPORT 1,002.00 1 1 I f t RUN DATE 07/12/04 TIME 08:50:19 PENTAMATION - PERMITS MANAGER ��` awhlp>�,�+'s4 7 •• -:; J��''1 u! a �h x t 1�i //��'t i '•Y.t it�,� BOARD OF BUILDING REGULATIONS;( License CONSTRUCTION SUPERVISOR y Number Birthdate �05/13/1950 J � ` Expires 05/13/2004 jre 014�° .., S 1 , ad „!!fit r5i�.t�'.,,r JI y1t�.; �:.. .,.� !!•..r)� thy.�c� Restricted �00 MARTINM ODONNELL ,skr 1487 OLD POST.RD ti n 3;1,; r MARSTON(HILLS AI ',.02648 Administrator , ' 0 .mac i ..__....,x.,... ..__.. ....:. ._.......— -- 136 rtoe ili�tnfft ��tiiS1'it af �4f1tt�l�fPs - o ({ HOME IMPROVEMENT CONTRACTOR — Registration: 123941 Expiration: 4/25/2005 Type: Individual Martin W.O'Donnell Martin O'Donnell 1487 OLD POST RD. MARSTONS, MA 02648 x . Administrator �A Lt2o Cj , (YVJ-? f 0 SS s � P U N G-E.,— �L►.�N Yc,�-,c Tt 5-0-3 -774 -.IS39 . yais-U egg' I ,"Pr;Aro�0 14`ti2 7 1� _� 13 2. . s7u� " TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel \BLE Permit# � Health Division PJ— �7 -2 UJ �y- �3 7+L rJ Date Issued Z3 —1) 3 Conservation Division I � . Application Fee Tax Collector `..-- Permit Fee Treasurer Planning Dept. • AApo ddloonty, Date Definitive Plan Approved by Planning Board NOf00dSAfY�f�l�dlp@d� Historic-OKH Preservation/Hyannis Project Street Address 16 Z- Village 0J-Yw 11//1 r Owner &2T10L/L/S tH 4AJA/Y N Address JJ Z Gt/09%/S 4Y 7?0-4 � Telephone SZ)2— q2 9— 3 5E y Permit Request giee_r zf U 'A- SSl 7g_5 LW,-2UYL/J x_y � �©3 79ti')- v /Li Square feet: 1st floor: existing proposed 2nd floor: existing proposed Total:new r— uz r- Zoning District Flood Plain Groundwater Overlay En M Project Valuation Construction Type Lot Size Grandfathered: O Yes ❑ No If yes, attach supporting documentation. •Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: O Yes 0 No On Old King's Highway: 0 Yes ❑No Basement Type: ❑Full ❑Crawl Cl Walkout O 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:0 existing ❑new size Pool:❑existing ❑new size Barn:0 existing ❑new size Attached garage:0 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 �� soiti! BUILDER INFORMATION Name /t10S�e rJA-) Al' /'� Telephone Number -70— 2W I—gUC>c� Address ZV .SL POAI72)A/ S 7- License# Z�S 1061192/G'l D/eF V Home Improvement Contractor# Worker's Compensation# Z,6 /0 l q/0 D/2.oo 2, ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO SIGNATURE �`-�---- DATE L FOR OFFICIAL USE ONLY ARMIT NO. DATE ISSUED - MAP/PARCEL NO. ADDRESS YY ` VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION a FIREPLACE ELECTRICAL: ROUGH FINAL' PLUMBING: ROUGH r FINALVA ' GAS: ROUGH f FINAL FINAL BUILDING ; DATE CLOSED OUT. ASSOCIATION PLAN NO. The Commonwealth of Massachusens Department of Industrial Accidents ly - Office 911OYCSI692000s _ — 600 Washington Street Boston, Mass. 02111 Workers' Compensation Insurance Affidavit nn Ir2 n Qi-M en.----+ r2ie = tell n„ne. IoLuon- I ciry nh4ne 9 CJ 1 am a homeowner performing all work myself. 0 1 am a sole proprietor and have no one working in any capacity I am an employer providing workers' compensation for my employees working on this job. comoinrname / f '�? Jc ,J �/' T� �c.f✓:'�r //J:^_ . i ,in': K!, phone p: '7- L• UUrtranc- c __policy p — :J i art a sole propnctor, general contractor, or homeowner(circle one) and have hired the contactors listed below who have the following wor'Kers' compensation polices: s,LM sea it-nams�- --- -— - — --- -- -r 1-' -,e,�-wrr'-.S'•v.��^r+'irv.�..�:.y.-v � ....r.rrn-�q•warFf.CR�`M•T"ZP:i+Jvm�2'+py^V•_�gyl•. 7 W`aWY't^'K -y— �e�q�TRP�Yt^, 7 .w.--_. - - _.......w...� ..a.. i!v.:.fi�.iwC�Y:bt uL�sa'r`.+--�....'�.�.'::..bn.w:l SrL�a.�..:..v+� .�.c...�� w.iuC V✓:..�iriY.S:iGsl:row.?s.'. :9_M1)2Bv nxmc: _—_- -- iddrcs: city: phone a. insurance C9 - ';>,ttac�aitiooa Y tsCoeeestsan- Fsilurc to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to S1500.00 and/or one ycan' imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of MOM a day against me- 1 understand that a copy of this statement may be forwarded to the Office of Investigations of the D I A for eovcnge verification. /do hereby certify under the pains and penaltei4es o perjury that the information provided above is true and correct Signature V / � c/' Ge Date Print Hunt ✓�`%r'✓C� //v'✓��`�t�`�T Phone q 7 ci` %-'—1— `�z,v J official use only do not wntc in this area to be completed by city or town official Acif! or town: permitAicense N —Building Dcpartmcnt rJLiccnsing Board i O check if immedrart response is required oSelectmcn's Office oHealth Department contact pmon: phone is; mother Ir—,.W IN1?JAI r i • � 4 �III.1 n+• ps. - yt: �; ri y 1 �+ ILM1 I11`I ( tro 41 r _ e r / [am e o ttaj.., RECIST(ERED I issued by Date-Manufactured, 4 e FABRIC I N,UMBER TOPTEC INC. . : _ � ,• 51161/00 +: Z 1905 N.E. Main Street �1 '� �,• r tt 31.02 ' i Simpsonville, SC 29681 ' This4s to certify that the materials described are inherently flame retardant. } " 'PETERSON PARTY CENTER , :Name c 139 SWANTON;ST . gAddress ;r WINCHES SR State MA SIP U1890 :Cert�t`icatlon is hereby �riadethat: w - The•-articles deser I j-t.are flame retardant, approved and registered by the State Fire Marshal,sand that the fabric is in conformance with the laws of the State of California and .the Rules and Regulations of, tf�e State Fire Marshal. `Fabric'hays been tested and passes NFPA701-96, CPA184, ULC109r'M.VSS302 Method of,Application FUTURE END 40x40 BLACKOUT:WHIT r i Desc.-i 'tlon of.'iterrrcertifiecf: - _ F,p ;. x -1 .q r The flame Retardant Process Used WILL NOT Be:Rem,oved By Washing. y: I rOPTEC, 'INC:. � f MODE TU4040NSE' SERIAL # 203228. . . .�' , r•. ' Name_of`Production superintendent F t trate of tame a t�'< 1 FEGISTERED Issued b Date.Manufactured.. F FABRIC y ; s 4� .••.4 = , NUMBER TOPTEC, INC. 617i00 1905 N.E. Main Street 31:02 ; Simpsonville, SC 29681 This 'is to certify that the materials described r - - are inherently flame retardant. } Name PETERSON PARTY CENTER `' 1 139 SWANTON ST Address AAA 01890•- , 1 WINCHES'TER _State Zip Certification is Y `hereb ,made that: i . , i The ,ahkles;des646ed.are flame retardant, approved and registered by the State Fire Marshal and that- _ the fabric is �n conformance with the laws of the State of California and the Rules and Regulations of the-St te,Fire Marshal. Fabric'has been tested and passes NFPA701-96, CPA184, ULC109 ,MVSS302. ethodof Application ; ascription of MID 40x15 BLACKOUT WHITE item certified: ! r i i The Flame Retardant Process Used WILL NOT Be Removed By Washing. s TOPTEC, INC. i I ( MODE TU4(H5NSC 203616D # ' Name:ofProduction Superintendent SERIAL # i Assessor's.Office(1st floor) Map Parcel Permit# �� U✓� Conservation Office(4th floor)(8:30-9:30/1:00-2:00) Date Issued _ Board of Health(3rd floor)(8:15 -9:30/1:00-4:45) r Fee Engineering Dept.(3rd floor) House# /�� INE Planning Dept. (1st floor/School Admin. Bldg.) � BARNSTABLE. Definitive Plan Approved by Planning Board 19 ' ,e 9. ' TOWN OF BARNSTABLE Building Permit Application Pro' Street Address 10(9- Ig-A Village iy7 C-/ Owner Address /,3-5— Telephone y��- �� y L Permit Request ! c= 4 ,Q- 1"P.14 Cz� - it/ ,;r�foA.r .First Floor square feet Second Floor square feet Estimated Project Cost $ Z. �00 Zoning District Flood Plain Water Protection Lot Size Grandfathered ? Zoning Board of Appeals Authorization Recorded Current Use Proposed Use Construction Type Commercial Residential Dwelling Type: Single Family Two Family Multi-Family Age of Existing Structure Basement Type: Finished Historic House Unfinished Old King's Highway Number of Baths No. of Bedrooms Total Room Count(not including baths) First Floor Heat Type and Fuel Central Air Fireplaces Garage: Detached Other Detached Structures: Pool Attached Barn None Sheds Other Builder Information Name &L- &47ZE Telephone Number Address ?567 License# fyl� ,2 gTl>i✓ ��- S 14714 Home Improvement Contractor# ./0,3 71 1-1 (�;A'r'e yT Worker's Compensation# Z7 90520d 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 TOut�.�� SIGNATURE DATE _ �0,ve�2 7 BUILDING PERMIT DENIED FOR THE FOLLOWING so (S) � y� FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED = MAP/PARCEL NO. ADDRESS - VILLAGE OWNER ' DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ' ROUGH FINAL FINAL BUILDING • J�k DATE CLOSED OUT 3 ASSOCIATION PLAN NO. �p VE-1 - : . The Town of Barnstable • aeaxsr�atE, • 9� 1659. ,0�' Department of Health Safety and Environmental Services '°TEo ram•{' Building Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissioner For office use only Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MCL,c. 142A requires that the "reconstruction, alterations, renovation, repair, modernization, conversion, improvement, removal, demolition, or construction of an addition to any pre-existing owner occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors, with certain exceptions,along with other requirements. Type of Work: Est. Cost Address of Work: Owner's Name 4" y9titi✓n,to Date of Permit ApplicationZ % -7 I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job under S1,000. Building not owner-occupied Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: /0 7/ Da a Contractor Name Registration No. OR Date Owner's Name r SR DR DATE(MM/DD/YY) 'ACdRD CERTIFICATE"'..'OF LIABILITY 1N l,1#�>*4NCft'DR2 05/01/97 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Drake, Swan & Crocker HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 14 Lot's Hollow Rd. ,PO Box 429 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Orleans MA 02653-0429 COMPANIES AFFORDING COVERAGE David D Rust COMPANY Phone No. 508-255-3212 Fax No. A Assurance Co. of America INSURED COMPANY B Credit General Insurance Co. Paul J. Cazeault Etal DBA Paul J. Cazeault & Sons COMPANY Roofing C COMPANY D COVERAGES 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. CO TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR DATE(MM/DDIYY) DATE(MM/DDIYY) GENERAL LIABILITY GENERAL AGGREGATE $ 1,000,000. A X COMMERCIAL GENERAL LIABILITY CFP25552812 05/01/97 05/01/98 PRODUCTS-COMP/OPAGG 51,000,000. CLAIMS MADE a OCCUR PERSONAL&ADV INJURY $ 50 0,Q 00 OWNER'S&CONTRACTOR'S PROT EACH OCCURRENCE S 500,OOO. FIRE DAMAGE(Anyone fiire) $ 300,000. MED EXP(Any one person) $ 10,000. AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT $ ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) HIRED AUTOS i BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ GARAGE LIABILITY AUTO ONLY-EA ACCIDENT S ANY AUTO OTHER THAN ALTO ONLY: EACH ACCIDENT $ AGGREGATE S EXCESS LIABILITY EACH OCCURRENCE $ UMBRELLA FORM AGGREGATE $ OTHER THAN UMBRELLA FORM $ WORKERS COMPENSATION AND WC STATU- OTH- TORY LIMITS ER _ EMPLOYERS'LIABILITY EL EACH ACCIDENT $ 100,000. B THE PROPRIETOR/ INCL SWC17005900 08/09/96 08/09/97 EL DISEASE-POLICY LIMIT S 500,000. PARTNERS/EXECUTIVE OFFICERS ARE: EXCL EL DISEASE-EA EMPLOYEE $ 100,000. OTHER DESCRIPTION OF OPERATIONSILOCATIONSIVEHICLESISPECIAL ITEMS Roofing CERTIFICATE HOLDER CANCELLATION <:......>_ DONALD4 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND ON T E COMPANY,ITS AGENTS OR REPRESENTATIVES. AUTHORIZE E ATIVE ACORD 25-S(1/95) ©ACORD.CORPORATION 1988 The Cummunr+'eall1l of Afussuchusctts Department of Industrial,9ccidcnts of1C80J*/QYBSIJg'BUOAS ';i; _'_r•;�'' h(I(I {i'asJ►►nJ;tun Street Bostu►t.Afuvs. 02111 Workers' Compensation Insurance Affidavit zlpnl�ant Information• _ _: •Plestse PRINTIe�tbl - • name- `�/��'�✓!ti� location' / d_(t 4G4�_/7 c` D 5 —,�v/ nhone I am a homeowner performing all work myself. p I am a sole proprietor and have no one working in any.capacity r..__. .v. .:.,>:.,�^�^I;-"'•.....,.,,A•-.•Tr.-:cr.::�,a4!•!efa..P".r,�r+aF74c!w:'�.�'..r"'YpM°31._SR�. ."'w.-'ry"'°"P'-"' "�s..'3i... �•� '`--._._..r...: I am an emplover providing workers' compensation for tny,employees working on this job. company n•rn_i��/7V C� V �072Gj7"(/�i/ � ��✓7 ��1•�//� (/ address: City: /V/, �/L C S /�� d�to 4D nhone#• insurance co 4f-AOF/!1 iT 15`/ti",+L policy# [•�C f 7dOS90lJ O I am a sole proprietor, general contractor,or homeowner.(circle one)and have hired the contractors listed below who have the follo\ving workers' compensation polices: company name: iddress: Wit,• Rhone#• insurance co policy !_...__.'._. .-t_._...�_._._.__....!nn�s:✓: _'rawn._e.r�-r;•:_?�';yes'.i►1'•?��"?�rif_;;e''�s+'�r�^Ry�n^�iG'�7yfFd�I^J7al!cl'!>�"�` 'S�7;?,,,'�,��.._.a_y��.... compinv name: address: city nhone#: insurance co policy# :Attach additional'shcef if tieces_iary�.�.��_w�_:e�<;a.•��+,�,rt��'.t;_,,. ��''+' ''�e ' •+ �` '*� „�.�. "' --r"' Failure to secure coverage as required under Section 25A of NIGL'152 can lead to the imposition of criminal penalties of fine up to 51.500.00 andiur unc years'imprisonment as well as civil penalties in the form of a'STOP NVORK ORDER and a fine of 5100.00 a day against me. I understand that a copy of this statement may be forwarded to the omcc of Investigations of the DIA for coverage verification. 1 do herchr cerrif•«nr lie pains and penalties of perjuq,that the information provided above is true and correct. Signature Date Print nametl� 6� /l G�7„�=,Av y� Phone# .'official use unh• do nut write in this arcs to be completed by sit)•or toN•n ofDcial ". sin•or town: permit/liccnse# nBuilding Dcpartmcnt C3Liccnsing Board p check if immcdkatc response is required pSelecimen's Office t; oliealth Department contact person: phone#: nOther tm'iscd alb*NAI Vj DEPARTMENT OF. -PUBLIC SAFETY p !a ONE ASHBUR�N,.:PLACE, RM 1301 OCT 3 U 1c BOSTORY MA\,02108-1618 m77J„tfiUCTION SUPERVISOR LICENSE Fr)). P. Expires: Bin = 0�?6325 10/20/1997 - 1072� To: 00 =.<. ;_ :1ZEAUL^_' - '' i •_.; Detach bottom, fold sign on 17"Cl 111 i11 ST " : �{i :; : back, and laminate license card. 'RV1_1E, 1-i? 02655 ':: a�_�= Keep top for receipt and change - � ',of address notification. J�e 1.OucNco-ruueal��t 4�✓I�UWJQC/LlWe�ii = Restricted To. 00 23407 ?'UHIC SAFETY _ <. .::•1..:._S._ .t .._P\\t.,4R .ICERSE 00 - None _ Zxp res: Birthdate: 1A - Masonry only. 1t6i 21: '?1?0/1 .1 :0/n/:959 1G - 1 & 2 family Hones R failure to possess a current editiop of the Massachusetts State Buiilding. Code �^A� A � :AiEA'J5T is cause for revocation of this 11cense. C "ASS" ,13 HOME IMPRp.U ,^ Board of Bu�i:l, One*- st ;. Bost6n.. HOME IMPROVEMENT'-.'CQIjM :- Registration 1037:1-4" Type — PARTNERSHIP-.... CONTRACTOR PAUL J . CAZEJ Paul J . Caraa f, 09/98 22 G i dd i a'l'V--`R` >> Orleans MA;-:02 SONS ROOFI • �: fault. ��rj),• "R 'P.O. Box 278 . NA..02653` t I. COMMONWEALTH OF MASSACHUSETTS Assessors map and lot number ... .... � Sewage Permit'number ..... .3 7....�� / / Z SARNSTADLE, i House. number ..........................;.....�.Q... ....................... 9 rasa �D YPY tr' TOWN OF BARNSTABLE BUILDING INSPECTOR b APPLICATION FOR PERMIT TO ...............f/) ! ........7-d.......... .................................... TYPE OF CONSTRUCTION . c% =.K)...... ^? .......................U............ ...................f...................... .....................��.` �/..........19.. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location location ... ....... ../.SJ ... ............pl... ...............G. � .......................... cal G Proposed Use ........... ��!!............................ Zoning District ..............`.. ......../....................................Fire District .............0,0.40................................................. Name of Owner . /..t ,.1g;V ��(9ress l� .�'� �✓1 /�� .�.-�� 'Pr�lG�c' S. l Name of Builder ..........S.�eu er! ...!'-....�.A.u:../�..4?....Address .....9..�!.....0.i.CAS-leo....�........................ o.v Nameof Architect ................... .............................................Address ................................................................................... • l� Number of Rooms ........................ ......................................Foundation .... ... ......... �....... ...... Exterior ........ ........... -- ..................Roofing ............................/..�..,.Q..J............................................. Ozo.W. Floors ................... Fl...##.......................................Interior ...........� "'�/4r z ... .... .......... .. ............................................. Heating ..................................................................................Plumbing ..................:........ Fireplace ..................................................................................Approximate. Cost .................�.�as............................. ................. Definitive Plan Approved by Planning Board -----------_______-----------19________. Area . ....... . ............... Diagram of Lot and Building with Dimensions-- Fee O� SUBJECT TO APPROV,A'L OF BOARD OF HEALTH G�Q� 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. Name ...... tr.... -... ........................ Construction Supervisor's License ........... MANNING, COIUMIUS J. 26283 Build Addition No ................. Permit for .................................... Single Family Dwelling ............................................................................... Location ........................ ................. ......................................... Owner ...Co ................... Type of Construction E.-PM............................. 6. ................................................................................ Plot ............................ Lot ................................ Permit Granted .....April..."!........... .....19 84 'bate of Inspection ....................................19 Date Completed ............. .. ................19 Assessor's office (1st floor): I E TO Assessor's map and lot number ...... ....... ............................ "Board of Health (3rd floor): C\j Sewage Permit number ........................................................ 33AE �STABLE. Engineering Department (3rd floor)- 1639- numbir ..... ........ House ....................... .................... 0 gar APPLICATION PROCESSED 8:30=9:30 A.M. and 1:00-2:00 P.M. only TOWN. OF BARNSTABLE BUILDING INSPECTOR r- 7_ 7 APPLICATION FOR PERMIT TO ....... ...... ..........0(................ .............................. TYPEOF CONSTRUCTION .....47. ....................................................................................................... ................................................19........ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: ).97........................... ...............................................-r_.v.................. .................................................. Location .... .. .. ..........1 0-4 ...... Proposed Use .......S ............................................................................................................... ZoningDistrict ................ ............................................Fire District .............. ('I)....... ..................... At-4...................................................................... ... .............. . .... ..Name of Owner ....... ................Address 0z...... Nomeof Builder .....................................................1�.............Address .................................................................... Nomeof Architect ..................... ....).0 ...............................Address ........................... ........................................................ Numberof Rooms ........................./...U.J.A..............................Foundation .............................................................................. Exterior ....................................................................................Roofing .................................................................................... Floors ..............................Interior .................................................................................... ......................... Heating .............................................. ...I.A...........................Plumbing .................................................................................. Fireplace ..................................................d.j.�.......................Approximate Cost ...............1.0.10.0 ...................................... Definitive Plan Approved by Planning Board --------------------------------19-------- - Area .......................................... Diagram of Lot and Building with Dimensions Fee ............................................. SUBJECT TO APPROVAL OF BOARD OF HEALTH OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name .......... ........ .......C......... ..... ...................................... Construction Supervisor's License PZ72�O............... MANNING, NEIL A=117-132 No 29226.... Permit for ...Swimming,.Pppj,.... .. .. .............single.XAMIXY..WgIlin.................. Location ....... ........................Q19.t.p'.r.vi'Up.................................. Owner .........Neil...M4nA:L]Rg Type of Construction .....Flame........................... ................................................................................ Plot ....................... Lot ................................ Permit Granted .......April r.1.1...2.2......... .....19 86 Date of Inspection .....................................19 Date Completed .......................................19 �a,4l/° IZ17 Assessor's map,and lot number : .... �C J Sewage Permit' number rI� �Z 3.7....G"!/,U�.................... Z BARBSTODLE. i House number ................................ ........:..... 9p� SAS 0� e L .' TOWN OF BARNSTABLE BUILDING -INSPECTOR o APPLICATION FOR PERMIT TO ................;.q...�..0........ ......... .......................) ........................................... TYPE OF CONSTRUCTION o o.S'J.......�2A.Y. ................................. ....................-y.�-� ........, TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ... .......«� -.../.,? y... ..............!..��/...y f/l G G ............................ ProposedUse ............._22�N.............................................................................................................................................. ZoningDistrict ........................................................................Fire District .............4 ............ ............`....................... Name of Owner �t' �—./. ......1� /t�� /1Ad ess .�� ..`r�Z�l„�✓��,f.. ,/i.`.... /mil//GAL /GG Name of Builder .......... ...Address ..... ..K Nameof Architect ..................................................................Address .................................................................................... . l� Number of Rooms ......................../......................................Foundation .... . .... :'""` ® .............. 4 Exterior ........f.....W'2 .//1��9.-Z_..4�5...................Roofing ............... ... -`.................................. Floors � Interior .............!.i�1" /��..� ..................0_,.xee��............... Heating ........................................1.........................................Plumbing ...................-` :.................................................Fireplace ...................................Approximate Cost . *"*******"*,**,* .t................. ------�9- Area ..........n Definitive Plan Approved by Planning Board __________________________ . ............................. Diagram of Lot and Building with Dimensions Fee O� ........^ .f��........................ SUBJECT TO APPROVAL OF BOARD OF HEALTH GfQ� 30 ---�1r t 1 p ._.._............... __��_ - g,V go, 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. Name ........................................... ........................ Construction Supervisor's License ........... MANNING, CORN1MIUS J. A7--117-132 I17-/ZZ 26283 Build Addition No ..... .......... Permit for .................................... ..........agigjg'.Far-jy..p.w Far ...................... Location 102-We5t..54Y..RQAd........................... ............... le.................. ........................ Owner .....WMelit15...J,...1�1Z1 ag................. Type of Construction ..France...... ................................. ............................. .................................................. Plot ............................ Lot ................................. Permit Granted ..APKil..11.1...................19 84 Date of Inspection ....................................19 Date Completed ......................................19 3 P-4- � TOWN OF BARNSTABLE ,639. BUILDING INSPECTOR � APPLICATION FOR PERMIT TO ----------------.------.-------.-----'------ ��2 �F �� -------------_-------------'--------'--------' � . � ^ ................................................ g........ TO THE INSPECTOR OF BUILDINGS: The undersigned 6une6y applies for o pannh according to the following information: Location .................................................................................................................................. ~J-^'~ ........................................ � � �N� - Proposed Use ----_—,.`. '. , ".--..—.:�:��2—..��..... .................... Zoning District ------.----.------------..RneDixtrict ---.—...oxr�, ,----.--------.---- '| ' A66 ^�� !�� Name of Owner --'^—...^--._----'-.`------' neo ---------...�..----. `�, ^~.. Plumbing .07 Diagram of Lot and Building" with Dimensions^ Fee ... SUBJECT TO APPROVAL OF BOARD OF HEALTH /l \ ` . ^7 ' ^ | hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. -. r Dl1m' Carmen W. 1=117~133' 18959 dormer No ................. Permit for ------------ - - - ---------^---------`--'----`' \� Bay Boa6 Location ----lO2— . - �—.—eat --.—~-------- ~ Ootervllle ----------.------~--------- ' Carmeog Elio Owner ------_---..�-----------.. , frame Type of Construction -------------- ' , ^ . ----,---'--.---.—^----------. Plot - Permit" . Granted" '`°°° / Date of Inspection ~ ' Date Completed . ' . . ' | . . PEmmmn RmF�U ' ' ' | ' | le � n . / ` � .......................... l� � � . -------------'----.. ----.. � ��~��`��' ,''�,,� _ � � ^ ' - - i G 7' _ EphVT1*4 Fit-e� J P �4�yt 7 pe°L Ot to 13 Z ° !; 7 b.} ; PPL V C A-. •I M A TOE ON_�_ :_._._.._. ..._ I _ }A - Assessor's office (1st floor): t ® /��T/C,^� �THETo Assessor's map and lot number ...... ../........../`.�.a..... ��L� `�?�� P° �`♦ Board of Health (3rd floor): 4 - 2 3 � ,��/ {t{0/��N C®Mp Sewage Permit number .........................................._............ �01VA4 �'/p� L/A ! BAWST&BLE, i Engineering Department (3rd floor): _,./ a a ,rn p� rorV�q�N7At C C 900 039. em0 House number .............................. . ..../.................o.U.............. eC9F ®®Z APPLICATIONS PROCESSED 8:30-9:30 A.M. and 1:00-2:00 P.M. only 7 TOWN OF B-ARNSTABLE BUILDING INSPECTOR 11U ST A Lt 5�-►�h P �ni �o o l 4' �Z-7 APPLICATIONFOR PERMIT TO/....................................................4....................................................................... TYPE OF CONSTRUCTION ..... -;N,N %T� ................................................................................:.............................. ................................................19.......... TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ....Y 0.Z..... .S.T.... Ai.....� 7 0--4 J\L`. ..t........................................................................................ ................. Proposed Use 1JC+ 4V.!` ...... .w!.!! .M! `?. +..�oo.4.............................................................................................. Zoning District .................Co.C.............................................Fire District ................�?"....� �/!.... ........... .. ....... ....................... Name of Owner ��-� . . �!`�!'� N.�'........................Address /AZ.....`"�EST��4-1 'KO ........................... ................ ........ .............................. Name of Builder .....................................................................Address ......................................:............................................. Nameof Architect .........................r..�.�...............................Address .....................................`............................................... Numberof Rooms ........................*AJ*l..A.............................Foundation .............................................................................. Exlerior ........................................... ./hr............:..................Roofing .................................................................................... �..`h..............................Interior .......... Floors .................................................. .......................................................................... Heating .............................................%"JA...........................Plumbing .................................................................................. Fireplace ' ".....................Approximate Cost 10.�.OoO ....................... Definitive Plan Approved by Planning Board ________________________________19-------- . Area .......................................... Diagram of Lot and Building with Dimensions Fee 4`�t.�................ SUBJECT TO APPROVAL OF BOARD OF HEALTH OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ...... ............. ............ Construction Supervisor's License ............... MANNING, NEIL No 2.92.2.6..... Permit for .................................... Swimming Pool Single. �,ARiilv Dwelling.................... Location .......1.02..W.e.s.t...Bay.,Road.................... Asterville................................. Owner ......Neil Manning................................. .............:............... Type of Construction ...Frame............................. ............................................................. .................. Plot ............................ Lot ................................. Permit Granted ......ARril 22, 86 ............................. Date of Inspection ............................. .....19 Date Completed .......... 19.......... ..... i Assessor's map and lot,number .....;..1..). .�.�...J......L A.J 6L SEPTIC SYSTEM MUST BE INSTALLED IN COMPLIANCE Sewage Permit number ........�Gf,L. . ....•�• . g � • • y• •• •• � � � WITH ARTICLE II STATE §ANlTARY CODE AND TOWN THE TOWN .O F B A R N =' 'ABE E Z BARNSTABLE, i "3` BUILDI-NG INSPECTOR D.YPY a• APPLICATION FOR PERMIT TO ..: .. ... ...................' ....... TYPEOF CONSTRUCTION .... ..............................................:........................................... ' .o..l.�.................197.7. TO THE INSPECTOR OF BUILDINGS: . The undersigned hereby �applies for a permit according to the following information: Location ./.. .........f-tJ•F�... ? .0!G..............................................................•••:•, ... .. . ..................................... b mProposed Use .. 1: ...../�......r J ...k.. ...... .................. Zoning District .........................................:..............................Fire District ..� .............................:.. ................... T Name of Owner ....C� i7i ...�Z'+ ,.......................Address ............................ �. � ,....... Name of Builder ..... unu..............................Address .... .w.. %�. ..CeZ:..................................... Name of Architect ...... .cx�.. ...........................Address ..... !��.lt !�4i. / 'fX�.............................. Numberof Rooms ..................................................................Foundation ...01.4 mlclaw4..................................................... Exierior �. .........................................Roofing ..... .................................. o�. .................................Interior .....� Floors ..... ........................................................... .................... Heating ..............:..................................................Plumbing .................................................................................... • ii Fireplace .1 .............................................................................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 6A . ................................ ow ` L I hereby agree to conform. to all the Rules and Regulations of thtoof *erdiing the above construction. Name ....................... .......................... Elio, Carmen W. 18959 do No ................. Permit for ..��^ .......... \ � ~ ' .................................... .......................................... . Location .......lQ3..W.emt_Bay..R.o.ad.................... Ootmrnillm ' ----.-~-----.---.-----.-----.. . Carman W. Elio ' Owner --------..�------------.. �rama ~ ' Type of Construction -------------- -..-.--.--..--------.--..------ ^ ' . Plot ............................ Lot ................................ ^ . February 22 77 - ' ,Permit Granted ---.. --]9 ' . Date of |no ' -.-l9 ' ' - ' . ' 'Do/a Completed -7�//��-��---..]� , . . ^ / . PERMIT REFUSED ' --~'''''~--,-''--.---.---_- 19 ^ ° .-.. ,� . ° --.�----.--..----.-.`-----.- . ' � .._..—..--.-.-.~.-'.--...-.----.-. .-.�.-.-.-----......~----.-..^...-. . ~ ^ . . ' ...,.-.--,-..----........�--.-...-. . � ' . ' . Approved ................................................ 19 ' ------_-----------------... _ ` ^ -----------.--------~~-...... � . -