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0135 BERKSHIRE TRAIL
Oxford. NO. 152 1/3 ORA ESSELTE 10% '11 Fti�-••'� �. v ..,,r.r�r'^-,....-c'�l, :3 :... _ �? _e_�o -,.a"�'�i' ��_—.. - _ _ ' _",r't'.". _ _ _ _— _ __ .dam�: .!�'.�,� _"".'y�..r� '::� .•.ae;�i.��`;NPI.���r r. ,,,E Town of Barnstable *Permit# Regulatory Services Fee 6 m rths from issue date SARN6TABLE ' 6 Mass Richard V.Scali,Director i639 �� `0. Building Division Paul Roma,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Map/parcel Number Not Valid without Red X-Press Imprint ``-- � T� ((���_ Property Address r1,3� �5►11 1�- W, 4J�fn-j, fg�>/,e rvl'e=� . Q 1—9- f�Residential Value of Work$ Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address �llr Ci�101 � ��• dh�' t He , 1'Y►c-,. Q-06�449 . Contractor's Name D r 1V �+�G(-G� Telephone Number Home Improvement Contractor License#(if applicable) Email: Ga'&1M�; L Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: I am a sole proprietor I am the Homeowner SEP 0 9 2016 ❑ I have Worker's Compensation Insurance �L Insurance Company Name �� 4QF BARNSTABLE 1Ua �'ir���h'JGi� ��y � j'� � Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ® Re-side ❑ Replacement Windows/doors/sliders.U-Value ��a�1 (maximum.32)#of windows `J #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *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 �j required. TSIGNATURE: T w� QAWPFILESTORMS\building permit formsEXPRE oc 06/20/16 The Coaruromveakh ctf Maysadmse& Deeparbueut of1ndks[n-d lcdderrfs O ice of "W--digmions. ' 600 Washirtgtart S`Ireet Boston,M4 02111 kvrvt�nras�gov�dia Workers' Canipensaf an.Insurance davit Buffiers/CantractorsMectr mnslPkmbers Applicant Infarmaf an Please Print E ly Maine ai - . - '��f'k (.�e�e rVn G� QX— A,daFesr 13t BCr'IcS Try, cam rhs4cJ,,,,,1c <rn-4 CifgfSfattl igt�+� rt.J G • Phone 5��� Are you an employer?.Checkthe appropriate bom Type of project(required): 1.❑ I am a employes with 4 ❑I am a general contractor and 1 6. ❑ �M employees(full a for part dime * bave hired tfie sub conbmctm 2.El am a sale proprietor orpartner- listed on.the attached sheet ?. Rr�odeiffig. shFp and have no employees . These sub-cantractars have 9- ❑Demolition woddng forme in any capacity. employees and bnre wodcars' 9..❑Building addition [No ems' comp-insumnr a comp-msuranCF f - 5. ❑ We are a corporation and its 10:El Electrical repairs or additionsrecluued] 'officers have exercised their IL Plumbin repairs or ad&tions Alam a bnmeotic�er doing all work ❑ g eP i myself[No workers'camp. right of exemption per MGL L_❑Roof repaim insura=e required-]i c.152, §I(41 andwe have rho employees.[No workers'' 13.❑O fier co=p-insurance g ,, e, *Any appficlatihatchedcs box ftlmastalsoMoutthesectimb6 wshmvagleawadereeompeasafian•peRgyin5==ffan. fi Mameowners who sabmitt ibs of ul2vit i-xffcating&ey am d b<zU wcA sir-&Him]site outside r,+,n.Rcft =mst submit anew affidseit mdi-fine SQCIL ZCaaunc- fRe cherY this bas nail xftr1yed as additi®sl street showing the name of the subta=xctum sand state whether ar not those entities 1 employees.If the sab•contmdurshave employers,thepxmtstpmvide then wo>m'imp.policy nvmlrer I am an Sdoiv is fife parlicy rind job site inform dam Insurance Company blame: Poficy 4,or Self-ins.I.ic-4- Expiration Date: Job Site A&re= cityl5tafer4p: Af#ach a-wpy of the workers'compensationpolicy declaration page(showing the policy,mtnrber and expiration date). Failure to secum coverage as re4*ednuder Section 25A o€MGL c 1572 can lead to the imposition of criminal penalties of a fine up to$L54Q00 sndror orie-gar itnprisoumeak as weU as tip penalties is the forts of a STOP WORK ORDER and a rue of uplo$250.00 a dap against:the violator. Be adsdsed brat a copy ofthis statercent maybe forwarded to the Office of Irrvest gatiorrs ofthe DIA for iassurance coverage vedfication- I da her-Bby teddy uudar the andpsrtab&r ofpedimy firatthe it:fbrmatimprmi&d abm a is true and correct �SyZ— O, ial axe only. Do not mrite in ffd s area,€a be completed by city artown awl Cky or Tawn: Per>nit Ucense; Issuing Anfliority(drele one): L Bond of Health r.BuffiSng Department 3.CAj4rown Clerk 4.Electrical Inspector S.Phunbfi g Inspector 6.Other Coact Person: Phone 9: 6 - ormation. and Instructions Ma&,z ] cetfs Ge:neml Laws amptz M rmq=m all employers to Xuvrde wow-'co:[P=sE±m for fheir'Play-ees- pmmiantln this ,an eznvlay�is deed as."_.everyperson in sae service of aa.oiher under any CD,ftart ofhfi-, =qnm s or implies oral Cr wriitr�." An Maya is def oed as`an ind3vOng parin�assochd6A corporafaon or aft=legal=thy,or MY two or more of the amgojog=gaged is a joint ,and including the legal relses of a deceased employes,or ffic rwziveT or trustee of an individual,parhneaship,assochfim or otherlegal entity,employing employees. However the ow=of a.dweIling house having-not mare than three apartme±s and who resides theaem,or the occqxmt of the - dweMag house of anofher who employs pmsons to do maim,caasfruct an or repair wo&on such dwelling inure or on the grounds err burldmg appre-, rrt hereto shall not becaase of each employment be deemed to be an employer_-" MC$,chapter 152,§25C 6)also slates that¢every' F fe or local Rce�g agency shall wiii�hOld$ne issaaace or renewal of a license or permit to operate a business or to construct buildings in the coramortwealth for any applicantwho has not produced acceptable evidence of cumpr=Ce with the hIWXance-coveXagee required." MCrL chapter 152,§25C(7)states 0Feifherthe nor any ofifs poIifical subdivisions shall Add�onaIly, - an i tD any contract for the perfinm ace;of public wotc until acceptable evidence of compliaAce with Ifie insane._ i regtm�uieZ3±s of dais chapter have been p==dMd to the oo—IXft a err =dY-" Applies PIm se fill oirt the wort =, compensation affidavit complobeT by checking the bones thatapply to yois srinatran anti,if necessary,Supply solHmntractor(s)name(s), address(es)and phone==ber(s) along with their cestfrcate(s) of In ce. Limited LiabilityCompHmes(LLC)or Limited LiabilityPart=ships(I.LP)wjano clployees o&erthanthe members or party are not regoaed to cry worbm-e compensation=arance If an LLC or LLP does have employees,a policy isrup ed. Be advised that this a$dayk may be sabmitfsdto theDep&riment of lndnstrial Accidents for conffimafum of inszu-aoce coverage Also be sure to sign and dale the afudavit The affidavit should be retnmed to 1he cify or town that the application for the permit or license is being requested,not the Department of r-r; ca,f�_ ShauId you have any questons regarding the Iaw or if you ai a rimed to obtain a wo�ra' compen e call sation policy,please the Deparhneat at t3ie rmmbca listed below. Self-fimnr-d companies should ear their self-fi snranc--license namber on fhe appropriate line. City or Town Of t Please besme that theaf davit is complete and printed legIly. TheDeparlmcntl=provided aspaceattheboll= of the affidavit for you to fM out in the event the Office of IuvestigatiDnS has to 60ntU t you regarding the applicant Please be sure to fill in the pen;ai/Iicense nwnber which will be used as a refe=ce number. k-atidition,an applicant at must sabmit muldple permiVIkense apply-cations in any given year,need only sobmrt one affidavit indicating cat th p olicY infoffia tine Cif necessary)and under`mob Site fi dares*the applicant should wri3�"all locations in (may or town)-"A copy of the affidavit that has been.officially stomped or madced by the city or town may be provided to e applicant as#oo-fthat a valid affidavit is on file for futrae permits or licenses. A new affidavitmust be filled oi th rt each year.Where a home owner or cidxm is obtaining a license or permit not related fD any bnsio=or commercial vans= (ie_ a dog license or pemart to bum leaves eb- said person is NOT zeqab:Ed to complete this affidavit The Office of Invesfigations would lilce to lhanlr you is advance for your cocpm-atim and should you have any questions, i please do not hem to give us a aaIL The Depar[menfs address,telephone and fax r.mnber_ ent of t,;�a}Accidents . AMA E�I,1F 2`a 4 61 T-727-49W=ft 406 or I-.V MAW,� Fax 617 727 7749 Revised¢24--07 ��� Town of Barnstable Regulatory Services ` dF Richard V.Scali,Director Building Division f Paul Roma,.Building Commissioner MASS 639. �� 200 Main Street, Hyannis,MA 02601 A www.town.barnstable.ma.us Office: 508-862-4038 . Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION DATE: " -7++.LUG b Please Print n It JOB LOCATION: •�-S �ee''1�5�� 1 r-r, 1 number street village "HOMEOWNER": -D1�'lc. srcT' name (� home phone# _ work phone# CURRENT MAILING ADDRESS: r 3s 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 procedure uirements 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,Ru-les&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 this issue is a form currently used by several towns. You may care to amend and adopt such a form/certification for use in your community. Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc 06/20/16 r Town of Barnstable Regulatory Services MASS. Richard V. Sca14 Director ► Building Division. Paul Roma,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 er of the subject property hereby authorize _ 5`�f to act on my behalf, in all matters relative to work authorized by this b ding permit application for: (Address of ob) **Pool fences and alarms are th responsibility of the applicant Pools are not to be filled or utiliz before fence is installed and all final inspections are performe and accepted. Signature-of Owner Signature of Applicant Print.Name Print Name i Date QYORMS:OWNERPERhOSIONPOOIS r Town of Barnstable BARNSTARLE. Regulatory Services MASS i639. Building Division �f0 MPy� 200 Main"Street,Hyannis,MA 02601 S Office: 508-862-4038 Fax: 508-790-6230 Inspection Correction Notice i Type of Inspection IlIPIY ( �r y'otiy SGd`F- OF ior If M f r- Location, 135' /RAIc bVR Permit Number Owner Builder One notice to remain on job site,one noti&on file in Building Department. The following items need correcting: ;c/0 j ,r�A rjT o� Wo a g T_/ M6-r old,,4-/A/ A) 14 i)� Q`A 46114V'qL 670,W)G � 1,5TierG? zkr2?&( !9-2—r . At 1 // 1 c t(,-43 " Please call: 5008�862-4eM "Al. Inspected wby Date 7/d 7 N . ^r1 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel ti `application # 14 Health Division Date Issued 7` S Conservation Division Application Fee (1� Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH Preservation / Hyannis • �N""� Project Street Address Village CoNEi:!�r . "Y t4::re&e Owner lD;l`K P h-)C41CY!5— Address 1,3` (-sh T Imo,r �• f3�{��� �, Telephone 56R-_13`7-176447- Permit Request l`) _-L,> C1`f0i LL k/ QV CC Wert i nee CAI`� I VI! OJ 1-->«C- G�i �-, �, A�r.�� ��r- ��e�(�ei �^� �c>►^r..e 12c�c,F' St1-; � ,�.�lt� ai�l � l.1Pr�' t.�'`a 1�-s- r ►a �l Yn, �-�, r� err r�1�- �7 (�1. �C <d c%�7 n:1-Q-�•epk�e I n' �. (.k 77 ,t rY?t &.6�a'' Square feet: 1 st floor: existing LID—proposed a 2nd floor: existing proposed Q_Total new d Zoning District Flood Plain Groundwater Overlay roject Valuation i.`;'C>D Construction Type- Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Ci( Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl UI'Walkout ❑ Other Basement Finished Area (sq.ft.) O Basement Unfinished Area (sq.ft) 1 Number of Baths: Full: existing Z new CJ Half: existing new C� Number of Bedrooms: 9 existing �[new U Total Room Count (not including baths): existing S. new 0 First Floor Room Count C> Heat Type and Fuel: YGas ❑Oil ❑ Electric ❑ Other / Central Air: ❑Yes YNo Fireplaces: Existing _New 6 Existing wood/coal stove: Yes No O � Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size _ Bari existing-' ❑ q6m size_ rY Attached garage: existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: o Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review # Current.Use Proposed Use rr+ APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name i Telephone Number Address License # r.5 04-Z27Z r,AJes+ r3c.rr!-.In J e rn Home Improvement Contractor# -.2, 4,6A� Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO jD(2 W) SIGNATURE - n-i DATE FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED c E MAP/PARCEL N0. 1 `« iA. ADDRESS ' VILLAGE OWNER F DATE OF INSPECTION: r *_'FOUNDATION.,:2 I FRAME j. INSULATION d FIREPLACE } ELECTRICAL: ROUGH "' FINAL PLUMBING: ROUGH FINAL ' 1 GAS: ROUGH. , FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. ' r = The Commonwealth of Massachusetts Department of IndustrialAccidents Office of Investigations i 600 Washington Street Boston,MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organiz ondndividual): 1>I( 'V �� ' �® U-ej' Address: ►?,i' � ��� � a W e ` r--1 6 L t-iS 5 te�i�= , ✓a City/State/Zip:.. fys. ( $ I d , Mti Phone#: Are you an employer? Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I employees(full with part-time).* have hired the sub-contractors 6. ❑New construction 21.E I am a sole proprietor or partner- listed on the attached sheet 7. [] Remodeling shrp and have no employees These sub-contractors have g. ❑Demolition workingfor me in an capacity. employees and have workers' Y P tY t 9.. wilding addition [No workers'comp. insurance comp. insurance. 10. Electrical repairs or additions required.] 5. ❑ We are a corporation and its eP 3.[ 1 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.[FfRoof repairs insurance required.]t c. 152, §'1(4),and we have no :. employees. [No workers' 13.[ OtherAdtAir comp. insurance required.] Ics Cov-•f IAA Pam. AO,-r` *Any applicant that checks box#1.must also fill oat the section below showing their workers'compensation policy information. t Homeowners who submit this dffidavit indicating they are doing all work and then hue outside contractors must submit a new affidavit indicating such. coontactors 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.Lic.#: Expiration Date: Job Site Address: City/State/Zip: .Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,-as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day-against the violatof. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby.certify under the pains and penalties of perjury that the information provided above is true and correct -Signstore: �� �� 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: w. Phone-#: r 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,employin "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." f MGL chapter.152, §25C(6)also states that"every state or local Iicensing 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( )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 youur situation'and, if. necessary,supply sub-contractors)name(s),address(es)and phone nuunber(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 notrequired 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 requiired to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should entertheir 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 perm.it(license applications in any given year,need only submit one affidavit indicating curreuit 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 firture 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 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 sliouuld you have any questions; please do not hesitate to give us a call. i The Department's address,telephone and fak number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. #617-727-49QO ext 406 or 1-877-MASSAFE Fax# 617-727-7749 Revised 4-24-07 www.mass.gov/dia i �•►+� Town of Barnstable Regulatory Services >�rrAB& Thomas F.Geiler,Director �E •`0� 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 1.3 Please Print DATE: JOB LOCATION: 1'55 1B car'I lf7k 1 r- Tram• i L C�J ' �Gt♦hs l�'�FiI`L number street village ,•HOMEOWNER": qt!;� YM ,� L.f- s oS�3�z- iYf-2 Sa 8=7737- �(L name home phone# work phone# CURRENT MAILING ADDRESS: IS I ��f�SI�JJ1��Y�t7 �i 1 Cy�� 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 an at he/she will comply with said procedures and requirements. Signature of Homeowne 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. C:\Users\decollik\AppData\Local\Microsoft\Windows\Temponuy Intemet Files\Content.Outlook\QRE6ZUBN\E}IPRFSS.doc Revised 053012 Town of Barnstable ti Regulatory Services • snlwsT"LF. • KASS. g Thomas F.Geiler,Director 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 eo'° v-Pr'ope'rty Owner MMust3 a_ ",�, ,,Complete and Sim This�Section If Using A Builder as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit. (Address of Job) **Pool fences and alarms are the responsibility of the appli�t.'POOls are not to be filled or utilized before fence is installed and all final inspections are performed and accepted. Signature of Owner Signature of Applicant Print Name Print Name Date Q:FORM&OWNERPERMISSIONPOOLS 62012 LOT 16 LOT17 i ��. LOT 18 Y Y RES. ZONE. "RF" This MORTGAGE INSPECTION plan is For FLOOD ZONE.- "C" Bank Use Onl TOWN: -ffZM R�BN�BLE- — _ REGISTRY OWNER: MUMAN.L'ALI'Y_ DEED REF: �6 1, — _ _BUYER: .-DJRFLP. REBECA L,�f .Y _ _ nTE: /�24_ _ _ PLAN REF:. 462Z34 _ _SCALE:1"= 50 FT. I HaT BY CERTIFY TO s'A1YafCH GQQF_E M1E RAArK_ --- -- ___________THAT THE BUILDING YANKEE SURVEY SHOWII ON THIS. PLAN IS LOCATED ON THE GROUND AS c PAUL SHOWN AND THAT ITS POSITION DOES ____ CONFORM CONSULTANTS _TO,4,THE ZONING LAW SETBACK "REQUIREMENTS OF THE .mil 40B (SUITE 5) TO WNW OF _ BARN�TABLF ____ __AND THAT • INDUSTRY ROAD .7.Y`IT-DOES, ..NOT LIE "WITHIN THE SPECIAL FLOOD HAZARD MARSTONS MILLS, MA. 02648 R ----- AREA'••AS ,SHOWN ON THE H.U.D. MAP DATED 6,/4D,h TEL 428-0055 -! Co u$ it "—Panel 250001 0015 C FAX 420-5553 .150 _ THIS PLAN NOT MADE FROM AN INSTRUMENT s 1A , E�PFf ---- SURVEY NOT TO HE USED FOR FENCES ETc. 15352 GG�If Barnstable Old Kings Highway Historic District Committee } 200 Main Street,Hyannis,MA 02601,TEL: 508-862-4787 Fax 508-862-4784 �ieuss. `rw APPLICATION, CERTIFICATE OF APPROPRIATENESS Application is hereby made,with five(5)complete sets,for the issuance of a Certificate of Appropriateness under Section 6 of Chapter 470,Acts and Resolves of Massachusetts, 1973,for proposed work as described below and on plans,drawings,or photographs accompanying this application for. Check all categories that apply; 1. Building construction: ❑ New ❑ Addition Alteration f: 2. jyM of Building: House ❑ Garage/barn ❑ Shed ❑ Commercial ❑ Otlier 3. Exterior Painting roof ❑ new roof ❑ color/material change,of trim,siding,window,door 1 4. Sin : ❑ New Sign ❑ Existing Sign ❑ Repainting Existing Sign 5. Structure: ❑ Fence ❑ Wall ❑ Flagpole ❑ Retaining wall ❑ Tennis court ❑ Oftr .' 6. Pool ❑ Swimming ❑ Other man-made pool ❑ Solar panels rd P P �� Oth'�y i•n� Type or Print Legibly: Date 5_ 2 -'3kQ 0 - NOTE All applications nual be signed by the current owns Owner(print): D I r K?6 VC IM cAn!;A<(J Telephone#: SO?-713`)--:2 S-y-2-- N.) ,r� Address of Proposed Work: r3s' L�'ic.5� e, t rc.,,L village c&.) esRlr Map Lot# ova i Mailing Address(if different) Owner's Signature Description of Proposed Work: Give particularYof work to be done: Go4 A i w �vim' Gycr-����a F-cr- P�re-c,f i uN: ^i?�PI�-, , ,'K ;� Z.�al i�'��n-• �,.-►cal Agent or Contractor(print): Telephone#: Address: Contractor/Agent'signature: For committee use only. This Certificate is hereb ROVE Date IfC. k ft-1 Members signatures jtsamD r MP�`� Z 4�013 GR° APPROVED JUN 12 2013 Town of Barnstable Old King's Highway 1 Committee Q:11 wdv and Commissions101d Kings HighwaylOKHApplicadonsMff 2O11 Cert Approprmteness.doc I I CERTIFICATE OF APPROPRIATENESS SPEC SHEET Please submit'5 Copies Foundation Type:(Max. 12"exposed)(material-bricklcement,other) Siding Type: Clapboard v1 shingle other Material: red cedar white cedar other Color. Chimney Material: r i Q,1G Color: i- cr► <' i Roof Material: (make&style) cc, 14-r,G L Color: 'S Roof Pitch(s): (7/12 minimum) 1 Z (speck on plans for new buildings, major additions) Window and door trim material: wood t"/ other material,specify Size of cornerboards iJc f a size of casings(1 X 4 min.) color C>f`c-�Z Rakes Ist member I A �' 2°d member _l k3 Depth of overhang Window: (make/model) material color (Provide window schedule on plan for new buildings, major additions) / Window grills(please check all that apply_: / true divided lights_ exterior glued grills_ grills between glass_removable interior None ✓✓✓ Door style and make: material Color: Garage Door,Style Size of opening Material Color . Shutter Type/Style/Material: Color: Gutter Type/Material: Color. ,JUN 12 2 Town of Barnst ay Deck material: wood other material,specify Color: Old Kinge Skylight,type/make/modeV: material Color. Size: Sign size: Type/Materials: Color: RECEIVED Fence Type(max 6')Style material: Color: MAY 2-4 20— Retaining wall: Material: a ,W Lighting,freestanding on building illuminating sign OTHER INFORMATION: THE ATTACHED CHECKLIST MUST BE COMPLETED AND SUBM17MD Please provide samples of paint colors,manufacturers brochure.of windows,doors,garage door,fences,lamp posts etc Signed: (plan preparer) Print Name 2 Q.I Boards and Commissions101d K fts Highway0KH AppliaotionslOKH 2011 Cert Appropriat m3&d x Jr � F+ ive °� Wit. :7,' •� r .i +' S � pay. , ,,. 3 -a�}.....1`�. - •� ..� n r d � r g _ a O J> l� On Q y Vf I �p��p • O J U II I. I..0 T ZIl 1 S a:� ' .�. f � �. i -•• .. 969E vs �� . '+.`PIS• .'a' v� f ' S A1,} n [� v icy BSI K14Z`15.— �yy -1._. ly J E C J Fl- � � i �C� �B � i —— ty r`� •I .. J J 2 • 'ici ice; ', I � S i f! + i Vb y\ I in or) Map ®� Parcel / Permit# House# Date FsSiier'j c�_ Board of Health(3rd floor)(8:15 -9:30/1:00- Ta- Fee LL.ED `- A13T,vs Conservation Office(4th floor)(8:30- 9:30/1:00-2:00) . A WITH TiT�pa, 5 Planning Dept. (1st floor/School Admin. Bldg.) Tr!',1 Definitive Plan Approved by Planning Board 19 BARN ABLE. MA p' �lED MAC��6' TOWN OF BARNSTABLE Building Permit Application Project Street Address j�S mte k i��'fZa ►L Village (.A j!e z4 Er ejr6 LE Owner D92k 4 Q�`'J�C�C,c� m o�GJX Address Telephone &Lr,&& iP rmit Request GJ 4 First Floor -7 Z a square feet Second Floor 5"7 G. square feet Construction Type C.�,rI n J Estimated Project Cost $ SG. 006 Zoning District Flood Plain Water Protection Lot Size i "CZ2 Grandfathered ❑Yes ❑No Dwelling Type: Single Family [3 Two Family ❑ Multi-Family(#units) Age of Existing Structure cc ii1g_ Historic House ❑Yes ❑No On Old King's Highway E(Yes ❑No Basement Type: ❑Full El Crawl "alkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) r7`L a Number of Baths: Full: Existing Z New Half: Existing New No.of Bedrooms: Existing -7, New Total Room Count(not including baths): Existing ; New L First Floor Room Count ?, 1 Heat Type and Fuel: Gas ❑Oil ❑Electric ❑Other Central Air ❑Yes �lo Fireplaces: Existing INew Existing wood/coal stove ❑Yes �lo Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) T(Attached(size) i ❑Barn(size) ❑None ❑Shed(size) i ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# Current Use Proposed Use Builder Information Name ► (G I� pY1 o w U� Telephone Number Z Address `� Ite ��., ,¢•� `f'�1 c. , L License# f v E Home Improvement Contractor# Worker's Compensation# 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 -�k S h a nJ SIGNATURE /`—�/Z' ' DATE '5—//j � BUILDING PERMIT DENIED FOR THE FO OWING REASON(S) FOR OFFICIAL USE ONLY �• ��PERMIT NO. ?2D �f DATE ISSUED *� MAP/PARCEL NO. ADDRESS VILLAGE OWNER t DATE OF INSPECTION: FOUNDATION- - FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: 1 ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING - DATE CLOSED OUT,- ASSOCIATION PLAN NO. Maloney Kathy From: Maloney Kathy To: Smith Robert Subject: Form of Notice of Casualty Loss to Building Date: Monday, September 11, 2000 3:29PM Your office just forwarded a"FORM OF NOTICE OF CASUALTY LOSS TO BUILDING . "to us for comment. Insured were Dirk P. and Rebecca L. Monger. Apparently, this was originally forwarded to you from John Klimm on 8114/00. 1 have checked our file for that address and find no current permits. I'm not sure exactly what the issue is but my guess is that the form just went astray and should have been sent to us, the Health Dept. or the Fire Dept. I believe these are routinely sent when there is an insurance claim over$1,000. The notification gives departments with a potential interest a 'heads-up'. In the Building Division, we just pass them along to the inspector for the particular village. Please let me know if you need additional information. Page 1 Tj 4. r ' The Town of Barnstable r r " . Office of Town Manager 'O�En Ma+ ► � 367 Main Street, Hyannis MA 02601 Office: 508-862-4610 John C. Klimm,Town Manager Fax: 508-790-6226 MEMORANDUM TO: Robert Smith,Town Counsel r FR: John KJE=95?� DT: August 14, 2000 RE: Insured: Dirk P &Rebecca L. Monger Claim No. CJ0008012A For your information, attached is a Form of Notice of Casualty Loss to Building.regarding the above-captioned claim. Thank you. JCK:lmb Fr AUG 14 1:::�20107 r y FORM OF NOTICE OF CASUALTY LOSS TO BUILDING UNDER MASS . GEN. LAWS , CH . 139 , SEC. 3B TO: BUILDING COMMISSIONER OR BOARD OF HEALTH OR INSPECTOR OF BUILDINGS BOARD OF SELECTMEN BARNSTABLE TOWN HALL BARNSTABLE FIRE DEPT. 367 MAIN STREET ADDRESSES P.O. BOX 94 HYANNIS, MA 02601 BARNSTABLE, MA 02630 ATTENTION: FIRE PREVENTION RE: INSURED: MONGER Dirk P. and Rebecca L. PROPERTY ADDRESS: 135 Berkshire Trail West Barnstable, MA 02668 POLICY NO. HO 0053090165-2 LOSS OF Water Damage on August 3, — 2000 FILE OR CLAIM NO. CJ0008012A .. CLAIM HAS BEEN MADE INVOLVING LOSS, DAMAGE OR DESTRUCTION OF THE ABOVE CAPTIONED PROPERTY, WHICH MAY EITHER EXCEED $1,000.00 OR CAUSE MASS. GEN. LAWS CHAPTER 143, SECTION 6, TO BE APPLICABLE. IF ANY NOTICE UNDER MASS. GEN. LAWS CHAPTER 139, SECTION 3B IS APPROPRIATE, PLEASE DIRECT IT TO THE ATTENTION OF THE WRITER AND INCLUDE A REFERENCE TO THE CAPTIONED INSURED, LOCATION, POLICY NUMBER, DATE OF LOSS AND CLAIM OR FILE NUMBER. SIGNATURE Jeffrey M. Seger T.M. SEGER CLAIM SERVICE, INC. 459 Washington St - PO Box 277 - Duxbury, MA 02331 Telephone (781) 934-9770 - Fax No. (781) 934-9194 ON THIS DATE-, I CAUSED COPIES OF THIS NOTICE TO BE SENT TO THE PERSONS NAMED ABOVE AT THE ADDRESSES INDICATED ABOVE BY FIRST CLASS MAIL. 08/07/2000 S GNATURE & DATE Ca erine M. Hepburn Secretary FORM 13 (5-1999) MAScheck COMPLIANCE REPORT 3 '7 � Massachusetts Energy Code Permit # MAScheck Software Version 2.0 Checked b /Djate CITY: Hyannis STATE: Massachusetts HDD: 5973 CONSTRUCTION TYPE: 1 or 2 family, detached HEATING SYSTEM TYPE: Other (Non-Electric Resistance) DATE: 9-11-1998 DATE OF PLANS: TITLE: COMPLIANCE: PASSES Required UA = 316 Your Home = 265 Area or Insul Sheath Glazing/Door Perimeter R-Value R-Value U-Value UA ------------------------------------------------------------------------------- CEILINGS 620 30.0 0.0 22 WALLS: Wood Frame, 16" O.C. 1920 11.0 3.0 147 GLAZING: Windows .or Doors 193 0.310 60 DOORS 21 0.350 7 FLOORS: Over Unconditioned Space 620 19.0 29 ------------------------------------------------------------------------------- COMPLIANCE STATEMENT: The proposed building design represented in these documents is consistent with the building plans, specifications, and other calculations submitted with the permit application. The proposed building has been designed to meet the requirements of the Massachusetts Energy Code. The heating load for this building, and the cooling load if appropriate has been determined using the applicable Standard Design Conditions found in the Code. The HVAC equipment selected to heat or cool the building shall be no greater than 125% of the design load as specified in sections 780CMR 1310 and J4 .4 . Builder/Designer Date MAScheck INSPECTION CHECKLIST Massachusetts Energy Code MAScheck Software Version 2.0 DATE: 9-11-1998 Bldg. Dept. Use CEILINGS: [ ) 1. R-30 Comments/Location WALLS: [ ) 1. Wood Frame, 16" O.C. , R-11 + R-3 Comments/Location WINDOWS AND GLASS DOORS: [ ] 1. U-value: 0.31 For windows without labeled U-values, describe features: # Panes Frame Type Thermal Break? [ ] Yes [ ] No Comments/Location DOORS: [ ] 1. U-value: 0.35 Comments/Location FLOORS: [ ) 1. Over Unconditioned Space, R-19 Comments/Location AIR LEAKAGE: [ ) Joints, penetrations, and all other such openings in the building envelope that are sources of air leakage must be sealed. Recessed lights must be type IC rated and installed with no penetrations or installed inside an appropriate air-tight assembly with a 0.5 clearance from combustible materials and 3" clearance from insulation. VAPOR RETARDER: [ ] Required on the warm-in-winter side of all non-vented framed ceilings, walls, and floors. MATERIALS IDENTIFICATION: [ ) Materials and equipment must be identified so that compliance can be determined. Manufacturer manuals for all installed heating and cooling equipment and service water heating equipment must be provided. Insulation R-values and glazing U-values must be clearly marked on the building plans or specifications. DUCT INSULATION: [ ] Ducts in unconditioned spaces must be insulated to R-5. Ducts outside the building must be insulated to R-8.0. DUCT CONSTRUCTION: [ ] All ducts must be sealed with mastic and fibrous backing tape. Pressure-sensitive tape may be used for fibrous ducts. The HVAC system must provide a means for balancing air and water systems. TEMPERATURE CONTROLS: [ ] Thermostats are required for each separate HVAC system. A manual or automatic means to partially restrict or shut off the heating and/or cooling input to each zone or floor shall be provided. HVAC EQUIPMENT SIZING: [ ] Rated output capacity of the heating/cooling system is not greater than 125% of the design load as specified in sections 780CMR 1310 and J4.4. MISC REQUIREMENTS: [ ] Refer to 780 CMR, Appendix J for requirements relating to swimming pools, HVAC piping conveying fluids above 120 F or chilled fluids below 55 F, and circulating hot water systems. ----NOTES TO FIELD (Building Department Use Only)------------------------- i .W MAScheck COMPLIANCE REPORT Massachusetts Energy Code Permit # MAScheck Software Version 2 .0 C ecked by/Date CITY: Hyannis STATE: Massachusetts HDD: 5973 CONSTRUCTION TYPE: 1 or 2 family, detached HEATING SYSTEM TYPE: Other (Non-Electric Resistance) DATE: 5-8-1998 DATE OF PLANS: . TITLE: COMPLIANCE: PASSES Required UA = 316 Your Home = 263 Area or Insul Sheath Glazing/Door Perimeter R-Value R-Value U-Value. UA ------------------------------------------------------------------------------- CEILINGS 620 30.0 0.0 22 WALLS: Wood Frame, 16" O.C. 1920 15.0 3.0_ 128 GLAZING: Windows or Doors 193 0.400 77 DOORS 21 0.350 7 FLOORS: Over Unconditioned Space 620 19.0 29 --------------------------------------------------.----------------------------- COMPLIANCE STATEMENT: The proposed building design represented in these documents is consistent with the building plans, specifications, and other . calculations submitted with the permit application. The proposed building has been designed to meet the requirements of the Massachusetts Energy. Code. The heating load for this building, and the cooling load if appropriate has been determined using the applicable Standard Design Conditions found in the Code. The HVAC equipment- selected to heat or cool the building shall be no greater than 125% of the design load as specified in sections 780CMR 1310 and J4 .4. Builder/Designer Date 5 1 1 Z 1v/ MAScheck INSPECTION CHECKLIST Massachusetts Energy Code MAScheck Software Version 2 .0 DATE: 5-8-1998 Bldg. Dept. Use CEILINGS: [ ] 1. R-30 Comments/Location WALLS: [ ] 1. Wood Frame, 16" O.C. , R-15 + R-3 Comments/Location WINDOWS AND GLASS DOORS: [ ] 1. U-value: 0.40 For windows without labeled U-values, describe features: # Panes Frame Type Thermal Break? [ ] Yes [ ] No Comments/Location DOORS: [ ] 1. U-value: 0.35 Comments/Location FLOORS: [ ] 1. Over Unconditioned Space, R-19 Comments/Location AIR LEAKAGE: [ ] Joints, penetrations, and all other such openings in the building envelope that are sources of air leakage must be sealed. Recessed lights must 'be type IC rated and installed with no penetrations or installed inside an appropriate air-tight assembly with a 0.5" clearance from combustible materials and 3" clearance from insulation. VAPOR RETARDER: [ ] Required on the warm-in-winter side of all non-vented framed ceilings, walls, and floors. MATERIALS IDENTIFICATION: [ ] Materials and equipment must be identified so that compliance can be determined. Manufacturer manuals for all installed heating and cooling equipment and service water heating equipment must be provided. Insulation R-values and glazing U-values must be clearly marked on the building plans or specifications. DUCT INSULATION: [ ] ' Ducts in unconditioned spaces must be insulated to R-5. Ducts outside the building must be insulated to R-8.0. DUCT CONSTRUCTION: [ ] All ducts must be sealed with mastic and fibrous backing tape. Pressure-sensitive tape may be used for fibrous ducts. The HVAC system must provide a means for balancing air and water systems. r TEMPERATURE CONTROLS: [ ] Thermostats are required for each separate HVAC system. A manual or automatic means to partially restrict or shut off the heating and/or cooling input to each zone or floor shall be provided. HVAC EQUIPMENT SIZING: j [ ] Rated output capacity of the heating/cooling system is not greater than 125% of the design load as specified in sections 780CMR 1310 and J4.4 . MISC REQUIREMENTS: [ ] Refer to 780 CMR, Appendix J for requirements relating to swimming pools, HVAC piping conveying fluids above 120 F or chilled fluids below 55 F, and circulating hot water systems. ----NOTES TO FIELD (Building Department Use Only)-----------------=------- Application to g 9 8 0 %8 , . �S�N NHS PapM'y!p VCTs , . gPp p!l.NS NpP lPN . Old Kings Highway.Regional Historic District Committee in the Town of Barnstable for a CERTIFICATE OFAPPROPRIATENESS Application.is hereby made, in triplicate, for the issuance of a Certificate'of Appropriateness under Section 6 of Chapter 470, Acts and Resolves of Massachusetts, 1973; for proposed work as described below and on plans, drawings or photographs accompanying this application for: CHECK CATEGORIES THAT APPLY: 1. Exterior Building Construction: ❑ New Building V4j Addition . ❑ Alteration Indicate type.of building: ® House ❑ Garage ❑ Commercial ❑ Other 2. Exterior Painting: ❑ 3. Signs or Billboards: ❑ New sign. ❑ Existing sigri ❑ Repainting existing.sign 4. Structure: 0. Fence ❑ Wall ❑ Flagpole ❑ Other (Please read other side for explanation and requirements)'. TYPE OR PRINT LEGIBLY DATE 4� I e ADDRESS OF PROPOSED WORK 13 T -i�EQ k-' ►F-G L �ASSESSORS MAP NO. Tr 41 OWNER _ PICA R. + 12�..h� c��a rsn0 c.s It ASSESSORS LOT NO. HOME ADDRESS 12 -ikZksl, iz.C —1?-.& C L..,'.P-4,- tz h-wil-lik EEL NO. C-2 1`4-3 FULL NAMES AND ADDRESSES OF ABUTTING OWNERS: Include name of adjacent property owners across any public street or way. (Attach additional sheet if necessary). I _ OJ 4 PG ryl V-9 IV 1cQ.t-5b 1 OC TRH i L C�CoRGs� I.io 7ec� . A ), (3c,e,� agl£ Irnu�►i /�.� �C � Zko ass f� i��h�KE TlZaii. AGENT OR CONTRACTOR �CfG(z ('�'1GN�`z�. TEL. NO. ��Z' IBIS 7 ADDRESS 135 F3EQIC--, i a TRc,- c.,, DETAILED DESCRIPTION OF PROPOSED WORK: Give all particulars of work to be done (see No. 8,other side), including materials to be used, if specifications do not accompany plans. In the case of signs, give locations of existing signs and proposed locations of new signs. .(Attach additional sheet, if necessary). /4d;n9 otA&A I �I�N to GciPz 5 hl6f hovst o . Signed Owner-Contracto -Agent Space below line for Committee use. Received by H D,,:C � {^' {^ - J pig" YIfiIlm L) i� i E Date r..The Certificate is hereb I 'l Is '� ;! Date , y ¢5 u :.Time A. . Approved ❑ IMPORTANT: If Certificate is approved, approval is subject to the 10 day appeal period provided in the Act. Town of Barnstable Old King's Highway Historic District Committee SPEC SHEET FOUNDATION Fc.,LL, Q45s.ry-,--,u+ Wi ih 'Wrii K OQ-" SIDING TYPE G,ZL-A cr2 G IC�Pf7o4e D COLOR G CHIMNEY TYPE COLOR ROOF MATERIAL So . j,,jc4V 3 TC.I7 COLOR PITCH IZ 1N f=PoN'I' y' PiEC:k GAl 0��I ?IT� GN LK wlNDow aNd 2 *S SIZE jlZorit 3o aV:N DA. T121PI4 TRIM COLOR DOORS t)c,4::,R Z. p� w�h '5 0Z IOT COLOR C?-Q&J R SHUTTERS. COLOR GUTTERS AL Uf-vi G (ZILI DECK. tom H 0lul N J �,C*I N GARAGE. .DOORS. �(.e; I COLOR CfZr-1 u B L1ZR SIGNS COLORS rdEti FENCE'.'.. COLOR NOTES: Fill out completely,. including measurements and materials/colors to be used. Three copies of this form are required for submittal of an application, along with three copies each of the plot plan, ' landscape plan and elevation plans, when applicable. Site plan should show all structures on the lot to scale. SPECSHT Y , Y� YYY , �� titi� sus LOT 16 ��• LOT 17 i TZ, LOT 18 RES. ZONE.- "RF" This MORTGAGE INSPECTION Plan is For FLOOD ZONE.- "C" Bank Use Onl TOWN: .4YZ5T- Hd8N1 A LE- — — REGISTRY OWNER: .K L' Uff 'Y— DEED REF: 1 — _ —BUYER: 111RK�� JMEM L—MON-GF� _— — DATE: /�254— _ — PLAN REF:. 46,2 34 SCALE:1"= 50__FT. I HEREBY CERTIFY TO �'A1Yjl��,y�QQPE�TIYE_8�K_ y Oi-- — _________THAT THE BUILDING YANKEE SURVEY SHOWN ON THIS PLAN IS LOCATED ON THE GROUND AS o CONSULTANTS SHOWN AND THAT ITS POSITION DOES _ __ CONFORM OL, TO THE ZONING LAW SETBACK REQUIREMENTS OF THE S ' 40B (SUITE 5) TOWN OF ---EAHAVISTABLF-------------AND THAT INDUSTRY ROAD IT DOES_ NOT_ LIE WITHIN THE SPECIAL FLOOD HAZARD MARSTONS MILLS, MA 02648 AREA AS SHOWN ON THE H.U.D. MAP DATED 6/-Q,/�,�_ s�ayAo5 TEL: 428-0055 Co m unity�—Panel 050001 0015 C 4iAN FAX 420-5553 �ADL A MEI�I��f ----- THIS PLAN NOT MADE FROM AN INSTRUMENT 15352 GCtII SURVEY NOT TO BE USED FOR FENCES ETC. ZME . T� : . The Town of Barnstable MAMDepartment of Health Safety and Environmental Services rEo " 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 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: ne,-" I In Est. Cost S"010C(lp Address of Work: 1?,g` ���'VS 1 Ll T i L C-i Owner's Name 1�)l if< P.� 2� Date of Permit Application: I hereby certify that: Registration is not required for the following reason(s): ' Work excluded by law Job under SI,000. Building not owner-occupied f_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 PROGIRAM OR GUARANTY FUND UNDER MGL c. 142A SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: Date Contractor Name Registration No. OR Sal�i l�l� ����-�(�.' r�-9��n►G�..�. . Date Owner's Name The Commonwealth of Massachusetts ^ = - Department of Industrial Accidents lid office of/ni/estigations ^ 600 Washington Street Boston,Mass. 02111 Workers' Com ensation Insurance Affidavit name: i�)1�1� � ry-aC� location city phone# ', cZ—Iqt 7 ❑ I am a homeowner performing all work myself. ❑ I am a sole ro rietor and have no one workin in any ca acity ❑ I am an employer providing workers' compensation for my employees working on this job. _.. .. comaanv name address. : ty . >.;.:.. ;..,.: shone# .. ci ..: insurance co. oltcv# %/ ❑ I am a sole proprietor,.general contractor, o =homeowne/r/ circle one)and have hired the contractors listed below who have the following workers' compensation polices: company name. f 91L . ... ,... .;;:.;. :;<;:>::..............:.......:::..:.. ..: :: :.......: - .. •. .... ;>;..';.r.y;:«<:.;;. i 't': :"i:i;'i' i C'ii i'i' address .::.:::...:........; city L1.i ..�,•::::i, i+b [stA r� i'r'lal 674 t, :�...........phone# --i""7 . tnsorence:co..::.. ..t.: . oLcv# .1.:1.:j:.:� . Ya s.... o: S�k: c� .....:.::.:::::::.::::::: camaanv name• ...<• ;;:�;;;:.;;;;;;:•;::•:::;•;:•;:::::::.: ....:...:...................... address city- 6E�ir fYt4ALl ;7�Y�'• .:.. .......... in-9urance<co.<:': ' MIX 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 form of a STOP WORK ORDER and a fine of$100.00 a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification 1 do hereby certify under the pains andpenalties of perjury that the information provided above is truo and/correct SignatureZ)2 Date Print name L i lZk k Y Y3n 0 A J(S`L 1. Phone#_ f. -x—i Li' � official use only do not write in this area to be completed by city or town official city or town: permit/license# []Building Department ❑Licensing Board ❑check if immediate response is required ❑Selectmen's Office ❑Health Department contact person: phone#; ❑Other (revised 9/95 P1A) Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the "law", an employee is defined as every person in the service of another under any contract of hire, express or implied, oral or written. An employer is defined as an individual, partnership, association, corporation or other'legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or g g g� J � g g P trustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance , construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer. MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally,neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority. Applicants Please fill in the workers' compensation affidavit completely, by checking the box that applies to your situation and supplying company names, address and phone numbers along with a certificate of insurance as all affidavits 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. City or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. The affidavits maybe returned to the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions. please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents Office of Inaestlgatlona ~ 600 Washington Street Boston;Ma. 02111 fax#: (617) 727-7749 phone#:•(617) 727-4900 ext. 406, 409 or 375 . •. _. - ::�',y.- �•-Y.7l.,�,ai:12�• .'>•'r' w;J."t+Yf '_A"'"y� •i' n..'Na'"..ti�:•l—Y'b ws;•:t:ti:t^.- ._yo .::2:x'^;..: n• f.:: :.. .. ..<s.a-. ,., °e,:��':y. S'�.,?..b/'.;Yer,.i� }`f-'•�...'.� �•,...•.:.:•.raz4"%`.-7Z-x ?.:h.f.S • yj:C ' ar o i^ . . �r. e^ y -L� It ki • - .. � � � � F'> ��r.��:t't.yet Iclf{�. p t 6r.,. 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A`IL _�: v.a .. - r ., ... .T.. _.'��:,:'�'')Y.-�.ni �.:�`.:v .. _ f. _ I .......... (Pi r � ► l 9/ Assessor's office(1st Floor): _ c p J t ;eST � r��� � �E f Assessor's map and lot number :� O O �'�/ 'r�Q, ��S���1� `"t> `� 'IMO IIALLED IN C�yMC�L�Q�NiCE c Board of Health 3rd floor: ( ) l + A WITH TITLE 5 'Sewage•Permit number J; ��, .' ' %ENVIRONMENTAL CODE AN Z DAHs9TULL Engineering Department(3rd floor): ry` TAN REGULATIONS +p r..a House number' _ �' o to 9. Definitive Plan Approved by Planning Board 1:k- 7 0 410 APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2`:00 P.M.M.on APP r B.A R N S T A B L E U�ILDING INSPECTOR l got, s APPLICATION FOR PERMIT TO �jv1��` // t l^� e—. TYPE OF CONSTRUCTION ��L7t'� (� ^� I ZS 19 TO THE INSPECTOR OF BUILDINGS: • The undersigned hereby applies for a permit according to the following information:Location L2'T icon t%r c%,n►n64-r bfc i 7 Proposed Use 5 sz:I C trn Zoning District Fire District Name of Owner_AnekQ-r _`Zi 31'C)Z�i� .Address /�� 'Fi oa� Name of Builder `) C ���-- Address S-C4 r . Name of Architect �t�r r�9��l 1,(/-% Address n 4 L4 Number of Rooms Foundation . Exterior /"Y, L Roofing L7� !� '>,::,f' r' t II / Floors V-- Interior r y114GL� 6 L Heating tA A • Plumbing ao��� Fireplace Approximate Cost Area I cA-�i( - Apace 42:::7s1F* Diagram of Lot and Building with Dimensions Fee 6 v\ OCCUPANCY PERMIT S:,RE0UIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regar ' th above construction. 1AIName Construction �Upervisor's License &A Ll ANCHOR DEVELOPMENT GROUP, INC. No 34892 Permit r 1Storv ' z Single Fami D , Location :Lot 1 7y Berk Trail West B to le t� Owner Anchor D el me , , Inc. ) j C Type of Construction F me ' Plot Lot Permit Granted Mar'-h a-1 9 , a 19 92 Date of Inspectio -.19 � 11 D to om leted 19 i v Ar :°vim � I f .• _ F-i 0 •� ' `. r y i 0 d ITS W s C +•�11 z`v a N09 PPS •o 0 0 cv o p O, Ol 05 � b2 0 � � • C ^C e 22 �. ., 'Z C) , . . 13 ;• N \ J 40 fv - .�. ,.o .. .s-.��:...:.. :}m•N1V�`A,e^":i��v:�j':�.�QwGfrs+^�-''�'b�ti�.r �Y...._ .. �:ii�$��r9y� I I .r aosa o. ��a \ - �s•S a��9 . 1411 Ve ra. a ptp_aaOQr Fig .i ®® r'o no.'a�u10r � 11 raQ•u 1 t�.l Mp n ; L L` 3B t ae oreoa•��?av era rru�e hh t¢ Left Side Elevation Front Elevation r idd`t! am sac non sa as.ar..e. a`i I��Ca`�y¢�t¢C g1�eE�v�gs¢i:;i �a/�am noc uo w nay.c �°0"m°"" m woa sv iMa e..un 12 / Z Cs] ro u \ O CL I e 1 1 Q I 0 ® ® > E F G 13 i I > a.K C, —3 I U Z Z till Q Z -� d Rear Elevation Right Side Elevation CY) b CI d a Wood neck ,v.it A rd .rd `a[ yit��4 s=c6 a Kylchen uA Bath ? e 4 lining- r. 00 '� 6 4 g •. Garage 0 ge zt.,4 © ® O Living r e` 4 Bedroom ..•d ` r-r 4 oom..rC��s•�o0 o ru. d, b' - �rt.�r�C �i�i'6P3P:•y ai�� S Batn 4 Bedroom Q @��l��y9�•• �rfnaV w R l.lS, <-<6t7ii o. Bedroom 6 t Hit 611-tlRaM! --a rd .Td e °O ss.•Y __1`�. ❑ r ® r_.v �.•_v r-f N Q Q u-r mn a .•d Z F� Z I .OH.yYwY A rd Q TJ.TMEDRA;cEu.sw First Floor Plan -� a O F Cr]In i STORAGE o 0 C p Oh I Second Floor Plan A co i.. 0,_W eS'46Y<,:yys, A�f a it �1YED 14GES _ I T6W " F BARNSTABLE Buiidin Inspection Department' a Y ' AOaY. �R _______ �Sai�•ar. rr Or.>a.',' yoan•,r oc n -- � yea!f�i ' •,roc _ � Sa�PeE ^gi< muY a ! • v>..a i.,..� Beth 11v11D Tr.o�.r�..e.m� HIM .ice..'o"`a•r ar. °"'m r 'e".ro.v"'caro.°°'^. , Rob nitii: � .__-._____._,r_r.., r o.a.,.•Roc •� ".I-------- __ii_e_�___i_a_------ -------------- Entry ">iaO.c rr.___ y ~ Kitchen 8 fBo { i Full Basement w...•rL ��; •.o>�m,.,..o..v it d E ' xr ru ma•.r ac i,. •sv1 s-r �• u ------• , _ ' I.9 140. , f roan ' -- mcwn.. ybu wO li Full Besment. e r ai. •m lilt. ti.o..r no,,aaan >� � '`-�� me •. P ------------ JJJ , i , i p6 1 }.... Typical Cross Section �1 ------------ ------•, „b„•., ..- --------=----=-- amom...•,� , W Z Q.-! 'Z O cc II/NOON SCHEDULE DOOR SCHEDULE W y xa Ox srzr Orr. aO. xrxaxxs xa OR Sur On. RO. rtr>naxs A Foundation Plan tL >O AO f.r • n.>r 'n_w• 'r^r Rdr uiw , sra,a ur•.'-0 Z L>]F -,..c.•a Q�� w•w.nu•• O A 3 ® f f a Y.u• pua�-f�.i•�•h -o.o�•a L•1 © Yi uoa o< >->,K.•-m of - Q O F f f > b.>T 4�•��t_-��L,� Ord? 0 y •/•-•/f V• ,1?.•'_,,? -w[»nomn� y.rR0 Oap Yl.O[�4D P.IN M,> "z U Z 7 Z 6 0 as co a �+p*Eti:...:.'+./.,.YF','.IttNtdliri.r�s�l'I�fiir:..•.. � .x v}!'DS��A•y.iv.:.vR4..al. .o d,. :>�6Mc}t�ir4+.�ah h.�t. e :a.rY!7E:6..,'.:�'t!.56s..a::.c,"y.'.::, .. ^c:4...•....r:.._c -•a'. .. ,.'. .• -_ Application to Old King,s Highway Regional Historic District Committee ((( in the Town of Barnstable for a CERTIFICATE OF APPROPRIATENESS Application is hereby made, id triplicate, for the issuance of a Certificate of Appropriateness under Section 6 of Chapter 470, Acts and Resolves of Massachusetts, 1973, for proposed work as described below and on plans, drawings or photographs accompanying this application for: CHECK CATEGORIES THAT APPLY: 1. Exterior Building Construction: C5 New Building ❑ Addition ❑ Alteration Indicate type of building: E,House ❑ Garage ❑ Commercial ❑ Other 2. Exterior Painting: ❑ 3. Signs or Billboards: ❑ New sign ❑ Existing sign ❑ Repainting existing sign 4. Structure: ❑ Fence ❑ Wall ❑ Flagpole ❑ Other (Please read other side for explanation and requirements). f TYPE OR PRINT LEGIBLY DATE �/ CL �G1 ADDRESS OF PROPOSED WORK I ` 1 ASSESSORS MAP NO. G > OWNER a, l.U:3o—,A_ ASSESSORS LOT NO. HOME ADDRESS dog L �r I` I �ZA14 , TEL. NO. FULL NAMES AND ADDRESSES OF ABUTTING OWNERS. Include name of adjacent property owners across any public street or way. (Attach additional sheet if necessary). n Ca.— S a- 661-ink c k::C1(Y �tn �� n') ( ,l ii : L,1n�CJ(-J ( I C- o2, I AGENT OR CONTRACTOR ✓ ✓ / TEL. NO. ADDRESS DETAILED DESCRIPTION OF PROPOSED WORK: Give all particulars of work to be done(see No. 8,other side), including materials to be used, if specifications do not accompany plans. In the case of signs, give locations of existing signs and proposed locations of new signs. (Attach additional sheet, if necessary). i AID ROVEDig Owner-Contractor-Agent QKHRH G Space below line for C mmittee use. G Received by H.D.C. ) A-"— C DateR E C E I V E she Certif• ate is eaeb 44nES14.t, Date 3— , Time MAP n 1991 By r11 n I� nlrc 141^I-�taf Approved IMPORTANT: If Certificate is approved,approval is subject to the 10 day appeal period provided in the Act. Disapproved ❑ _ Form t OLD KING'S HIGHWAY HISTORIC DISTRICT Spec Sheet Foundation Type �j(�(�� Siding Type v �-' - Chimney. Type ✓- Color �K-r,�X y t ,- Roof Material G Color Pitch 1� y Windows \/l/ Size `/C,�-i�,Cgx, Trim Color (����r,4s c�p.sv,,� _ �G'tcQ / 1"U`C � ��. s - _yr► Q � ,1�11 1 Doors - C`��P.1c.�1 c.�-g�tiL - Color �c,hr�lCsr�l��►^c ��ci� Shutters ✓� CaN Gutters Deck ti Garage Doors M[A� _t Color Notes: Fill out completely, including measurements and materials/colors to be used. Three copies of this form are required for submittal of an application, I along with three copies each of the certified plot plan-; -landscape �p�ian and elevation plan, when applicable. " �' OKHRHDC OLD K NG'S HIGHWAY :AKrgSTABLE, MASSA BUILDING , `�� , r CHUSETTS , N G PE �: . DATE Narc1 ii. .I 9 19 92 APPLICANT PERM NO.�1'.ti': G't" ADDRESS .. ,` . (NO.)' (STREET) (CONTR'S LICENSEI PERMIT TO .y1]:L.Li.:. �lY::.i. l.:i-i:'•.; J j ;,; �,, NUMBER OF (= ) STORY �.'. 1'<'.;::',.L.l," liWi'L}11"DWELLING UNITS (TYPE OF IMPROVEMENT) NO. (PROPOSED USE) AT (LOCATION) i-"- 1-• Tf iiti•jil. i'11 .L�.t .��2.•..:.1� '5•r JJ�aY:i"{i:•iL).1:.; ZONING (NO.) 1 .F (STREET) DISTRICT 1tZ, BETWEEN AND (CROSS STREET) (CROSS.STREET) `1 --SUBDIVISION LOT BLOCK LOT§IZ t' BUILDING IS TO BE FT. WIDE BY FT. LONG BY FT. IN HEIGHT AND'SHALL CONFORM IN CONSTRUCTI, TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION (TYPE) REMARKS: 1. _ W,I1:i•. ir9'2-74 AREA OR VOLUME J.3uU ESTIMATED COST 0oI.) $ ?u PERMIT 4i r� ,y ' (CUBIC/SO UARE FEET) FEE OWNER iliiC;;IG� iJ. L. I.: ,'•::Ii:. ti1.:;;L;;. r L ADDRESS 1 U•t C _ ;( ;•1 L :.t;, _ p 'i BUILDING DEPT. BY y` I l-; THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET, ALLEY OR SIDEWALK OR ANY PART THEREOF. EITHER TEMPORARILY C ?RMANENTLY. ENCROACHMENTS ON PUBLIC PROPERTY, NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE, MUST BE Al ION OF PUBLIC SEWERS MAY BE OBTAINE A THE DEPARTMENT OF PUBLIC WORKS. THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIOI VIED BY THE JURISDICTION. STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCAT Y APPLICABLE SUBDIVISION RESTRICTIONS. )N THREE CALL •APPROVED PLANS MUST BE RETAINED ON JOB AND THIS WHERE APPLICABLE SEPARATE .OF REQUIRED FOR *RUCTION WORK: CARD KEPT POSTED UNTIL FINAL INSPECTION HAS BEEN PERMITS ARE REQUIRED FOR ELECTRICALPLUM IONS OR FOOTINGS. MADE. WHERE A CERTIFICATE OF OCCUPANCY IS RE- MECHANICAL�INSTALLIATIONS.O pCOVERING STRUCTURAL QUIRED,SUCH BUILDING SHALL NOT BE OCCUPIED UNTIL ECTION BEFOREE E TO LATH). FINAL INSPECTION HAS BEEN MADE. Y. POST THIS CARD SO IT IS VISIBLE FROM STREET if iLDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVA 7�7 y/qv 3 HEATING INSPE IO APPROVALS ENGI ERING DEPAR MENT I /,cJx p B F HEALTH OTHER SITE PLAN R W APPROVAL _ • WORK SHALL NOT PROCEED UNTIL THE INSPEC- PERMIT w.,LL BECOME NULL AND VOID IF CONSTRUCTION '+'TOR HAS APPROVED THE VARIODUS STAGES OF WORK 15 NOT STARTED WITHIN INSPECTIONS INDICATED ON THIS CARD CAN SIX MONTHS OF DATE THE STRUCTION. PERMIT IS ISSUED AS NOTED ABOVE. ARRANGED FOR BY TELEPHONE OR WRITTI NOTIFICATION. ,�. ,*IMF , TOWN OF BARNSTABLE 3�892 . ................ BUILDING DEPARTMENT TOWN OFFICE BUILDING Cash 7 .Y� HYANNIS.MASS.02601 Bond ....X.......... I CERTIFICATE OF USE AND OCCUPANCY Issued to Anchor Development Group, Inc. Address Lot 1)17, 135 Berkshire Trail West Barnstable, tlass. USE GROUP FIRE GRADING OCCUPANCY LOAD THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. ff October 22, 19 /� - �/ .......... �.... - . ........................ Building Inspector i i a`����•'. TOWN OF BARNSTABLE BUILDING DEPARTMENT »ST TOWN OFFICE BUILDING rua t639. HYANNIS, MASS. 02601 MEMO TO: Town Clerk FROM: Building Department DATE: An Occupancy Permit has been issued for the building authorized by BuildingPermit Z�............................................................._......................................_................ . _.... .__. issued to A/��©/ _�G�/CL. f `Ov�1>..............?'o(_..1.�.I-L-` 1tr -/-G_ w' . Please release the performance .bond.