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0375 CEDAR STREET
OX?(07d'NO. 152 1/3 ORA ESSELTE' 10% i Town of Barnstable Building Department Services Brian Florence, CBO A AA Building Commissioner BAMSTABLE 200 Main Street, Hyannis, MA 02601 1639-2014 www.town.ba rnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Notice of Building Code Violation(s) and Order to Cease, Desist and Abate: Elsie Sampou, 375 Cedar Street, West Barnstable,MA 02668 and all persons having notice of this order: As property owner or tenant of the property located at 375 Cedar Street, West Barnstable. MA, Assessors Map 131 Parcel 062 and known as a residential structure, you are hereby notified that you are in violation of 780 CMR,the Massachusetts State Building Code Chapter 1 Section R105.1, and are ORDERED this date 7/7/2020 to: CEASE AND DESIST all functions associated with the following violation(s)on or at the above mentioned premises: Summary of Violation: On 6/24/20201 observed a violation of 780 CUR the Massachusetts State Building Code Chapter 1 Section R105.1 Specifically, Work has been done on multiple structures (roofing, siding)without a required building permit or approval from the Old Kings Highway Historic District. Summary of Action to Abate Violation: In order to abate this violation and to avoid further enforcement action by this office, commence immediately upon receipt of this notice the following action: Contact the Old Kings Highway Historic District to apply for approval and apply for a separate building permit for each structure describing the work that has been done. And, if aggrieved by this notice and order; to show cause as to why you should not be required abate the violation in this notice, you may file a Notice of Appeal specifying the grounds thereof with the State Building Code Appeals Board within forty-five(45) days of this notice in accordance with MGL 143 c. 100 and 780 CMR. If, at the expiration of the time allowed, action to abate this violation has not commenced, further action as the law requires may be taken. /B/Ayy Order, Robert Robert McKechnie Local Inspector 508-862-4033 Robert.mckechnie@town.bamstable.ma.us own-of Barnstable- ®uil .® — —_`z O,n - .r" --r _—a-.. ", .,'r'�e,. -`vx " 'wvtnk. rz.+�:a- 5° 'h ""n'`' 'Y':' �,+ ,XvT".�'6*a s''^<"?gg;' ^"£ •"� .. it M"'°�,". fl pxSs... : :.: : - �6 a '�:;q �..'�" "r••.�a4�e'yaaz�,. w.•,,�'�;::xe �`ti�G�'�.": .;;....v:�..e.�§ ''�.b , ,.y; �. .,�$� "✓'"'i+'"?.'�'a ..�' -. ���:����c ., PostwThistGardiSotThatitas,V.isibleaFrom-the=Street A . cooed:Plans,MustabeReta•med.onJobandthis,CardMustrbetiKept 7.,, ;...: .,,,: , r..r.:B,.v. - •*yw .,.3 ! :a--+ x>_ xi � ... ,.. s m pp.dr't"� -.-.'�..�£;.'.'��e S."-c:P^'�„''3.,. .� :,..'�. ..3... , �• .r'�,x,k�,.w+� .� , --..X"'�,xss r� ruxivs[we[cam, w= a 8t` v Mom. Postedr.Unt�I�Final=.Ins ection�Has»Been"Made" •�,�. � } '���., _,m°.��. e':.. 'ev= _ ;, � �' €''�t ��:�� `�����: �.�.r�y�x�. i6 , ;rp fir. ..: :".., .. d x ata 3 k ° :. 3A Termit' ' . -�:r� •. �Where��a♦Certificate:of�,O�ccupancy�is�Required;such�Buildmgshall�Not,,be,Occupied7u�nt�anallr%pe�on�`�-'habeen�a�de Permit No. B-18-375 Applicant Name: CAPIZZI'HOME IMPROVEMENT, INC. Approvals Date Issued; 02/09/2018 Current Use: Structure Permit Type:: Building- Siding/Windows/Roof/Doors Expiration Date: 08/09/2018 Foundation: ,Location:. 375 CEDAR-STREET,WEST BARNSTABLE Map/Lot 131.062 Zoning District: RF "Sheathing: Mgt p,. � Owner on Record:, SAMPOU, ELSIE TR � �� Contractor Name, CAPIZZI HOME IMPROVEMENT, Framing: 1 " g ' NC. Address: . 375CEDAR STREET ' rti 2 --Contractor-License: 100740 WEST BARNSTABLE, MA 02668 � y Chimney: Estes Pro ect Cost: $5,000.00 Description: re-roof stripping old - `En� � �I k Insulation: Permit Fee: $35.00 Project Review Req: PMN � m � � FeeP d: 5 35:00 Final: � ,� �1 2/9/2018 �Plumbing/Gas a 5 Y • - �-� - .. .::... . - �` ��,��� ,' '����, �'�,�-.- � Rough Plu mbing: , Final Plumbing: ¢Y ;: Building Official 41. Aough'Gasf This permit shall be deemed abandoned and invalid unless the work auth�izedt y this permit is commenced within siz moth after ssuance. ,� z tisP. Final-Gas:. ... All Work;authorized by this permit shall.conform to the.approved applic�� niandf h�e�approved construction documefoNwhiclh this permit'hes been granted. All construction,alterations,and changes of use of any building and straetur0sh91l.be in compliance with the.local zoning by laws and codes. t �z r This permit shalLbe displayed in a location clearly visible from access street orroad�and-,shall be,mamtamed open for public inspectionforthe entire duration ofthe Electrical t t work until the completion of the same. ,� r Service. The Certificate,of Occupancy,will not be issued until all applicable signat-uresbyrthe Build ngLghd; re Of eigls are provided',on this permit. Rough- Minimum of Five Call Inspections Required for All Construction Work:Lx �s� � •. " 1.Foundation or Footing Final:, 2.Sheathing Inspection 3.All.Fireplaces must be inspected at the throat level before firest flue lining is installed Low Voltage Rough:. 4.Wiring&Plumbing inspections to be completed prior to frame Inspection -5.Prior to Covering Structural Members(Frame Inspection) Low.Voltage,Final: , 6.Insulation 7.Final Inspection before Occupancy Health' Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Final: Work•shall.not proceed until the Inspector has approved the various stages of construction: Fire Department, F Persons-contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Final Building plans are to be available on site L' - All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT T of Barnstable _ _ Building �. Town e Post This Card'So That it is Visible From the Street Approved Plans Must b6,Retained on Job and"this Card Must be Kept ,: M ,� Posted Until Final inspection Has Been Made 't ;x �e�'n11t Where a., ertificate:of 0'. ant ;is,Re aired,such Building shall Notbe Occupied until a Final Inspection has been made , lgj . ...�r.. P Y q _ Permit No. B-18-375 Applicant Name: CAPIZZI HOME IMPROVEMENT, INC. Approvals Date Issued: 02/09/2018 Current Use: Structure Permit Type: Building-Siding/Windows/Roof/Doors Expiration Date: 08/09/2018 Foundation: Location: 375 CEDAR STREET,WEST BARNSTABLE Map/Loth 131-062 Zoning District: RF Sheathing: Owner on Record: SAMPOU, ELSIE TR .,,Contractor Name: CAPIZZI HOME IMPROVEMENT, Framing: 1 INC. Address: 375 CEDAR STREET 2 WEST BARNSTABLE, MA 02668 eT Contractor License:. 100740 Chimney : Project Cost: $5,000.00 Description: re-roof stripping old .. - Est. I Permit Fee: $35.00 Insulation: Project Review Req: i Fee Paid: $35.00 Final: Date: 2/9/2018 Plumbing/Gas l Rough Plumbing: Building Official Final Plumbing: N. Rough Gas: This permit shall be deemed abandoned and invalid unless the work authorized.by this permit is commenced within six months after issuance. _ Final Gas: All work authorized by this permit shall conform to the approved application and the;approved construction documents for which this permit has been granted. All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning.by-laws and codes. This permit shall be displayed in a location clearly visible from access street or road and shall be maintained-open for public inspection for the entire duration of the Electrical work until the completion of the same. Yf Service: The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials a`re provided on this permit. Rough: Minimum of Five Call Inspections Required for All Construction Work: 1.Foundation or Footing Final: 2.Sheathing Inspection 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Low Voltage Rough: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection 5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Final: 6.Insulation 7.Final Inspection before Occupancy Health Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Final: Work shall not proceed until the Inspector has approved the various stages of construction. Fire Department "Pe`rsons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Final: Building plans are to be available on site All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT oFn,e Town of Barnstable *Permit— 1q, — S-7 _ Building Department rX �es6monthstromissnedate Brian Florence,CBO ,� 3d' 1639.� �,� Building Commissioner.� Zi�� 200 Main Street,Hyannis, MA 02601 www.town.barnstable.ma.us Office(r�Qll A2OAn TBAKIM ABLF Fax: 508-790-6230 t EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY �/�p 62, Not Valid without Red X-Press Imprint Map/parcel Number 'f Property Address 37T Ge a4a.. y l'-- W Ur 44,0111—W 0/lC Residential Valtte of Work$ °"I ido, Ud Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address �5 1 f!e .fig -P Oy 3 y s Ce Contractor's Name geyg L o pey Telephone Number /uo �A� I_ Nome improvement Contractor License#(if applicable) z�o Email: - xH/ CAe � 2 QM t , Construction Supervisor's License#(if applicable) �rkman's Compensation Insurance Check one: ❑ 1 am a sole proprietor Vam the Homeowner have Worker's Compensation Insurance Insurance Company Name .�f /r �'� (e# 4 a Y Workman's Comp. Policy Copy of Insurance Compliance Certificate must accompany each permit. Permit Requ .t(check box) 0AI L 0 ly,4 � � ptz vejt/ �11ve I [YRe-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to /ow iJ o ❑ Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) o4l A/e't, j1l/(,`4 ❑ Re-side �" ❑ Replacement Windows/doors/sliders. U-Value (maximum.32)#of windows #of doors: Where required: Issuance of This pennit does not exempt compliance with other town department regulations,i.e.I listoric,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. copy of a Home Improvement Contractors License&Construction Supervisors License is eqc SIGNATURE: C:\Users\decolIik\AppData\Local\Microsoll\Windows\INetCache\Content.Outlook\9NNOKXY W\RESIDENTILONLYEXPRESS.doc 09/26/17 r 4' 9 i Page 7 of 7 Capizzi Home Improvement Inc. Specifications and Estimates STATE OF MASSACHUSETTS LETTER OF AUTHORIZATION TO APPLY FOR A BUILDING PERMIT WE, ELSA& ANDRE SAMPOU, OWN THE PROPERTY LOCATED AT 375 CEDAR STREET IN WEST BARNSTABLE, MASSACHUSETTS. I all l� I HAVE AUTHORIZED CAPIZZI HOME IMPROVEMENT TO ACT AS MY AGENT TO APPLY FOR A BUILDING PERMIT IN ACCORDANCE WITH 780 CMR, THE MASSACHUSETTS STATE BUILDING CODE. I GIVE MY PERMISSION TO LESSEE TO APPLY FOR A BUILDING PERMIT IN ACCORDANCE WITH 780 CMR, THE MASSACHUSETTS STATE BUILDING CODE. 7 SIGNATURE OF OWNER: OWNER'S ADDRESS: 375 CEDAR STREET, WEST BARNSTABLE MA 02668 OWNER'S TELEPHONE: (508) 362-6903 LESSEE'S SIGNATURE: LESSEE'S ADDRESS: LESSEE'S TELEPHONE: APLLICANT'S SIGNATURE: APPLICANT'S ADDRESS: 1645 Newtown Rd., Cotuit, MA 02635 APPLICANT'S TELEPHONE: 508-428-9518 RESPONSIBLE OFFICER: RESPONSIBLE OFFICER ADDRESS: RESPONSIBLE OFFICER TELEPHONE: t. - - Massachusetts Department of Public Safety C.+%/, nmmtarruva� �)'c�'�Q���� o„ Board of Building Regulations and.Standards Office of consumer Affairs&Business peg Y ` . HOME IMPROVEMENT CONTRACTOR .� License: CS-071402 TYPE:SuoPlefient Card Ills Construction Supervisor i Realry�A •E�IP_ation I up - I 06/22/2018 I 100740 : JOSHUA L COHEN .. CAPIZZI HOME IMPROVEMENT,INC. i 1082 OLD STAGE RD�3. .. CENTERVILLE MA 02632+' JOSHUA COHEN -' 1645 NEWTON RD. �` ! COTUIT,MA 02635 Undersecretary^i r,,1ZUZ- r Expiration: Commissioner 12/31/2017 I' 'Construction Supervisor f Restricted to: Unrestricted-Buildings of any use group which contain s F+t Registration valid for individual use only less than 35,000 cubic feet(991 cubic meters)of - before the expiration date. if found return to: ;I enclosed space. Office of Consumer Affairs and Business Regulation I { 10 Park Plaza-Suite 5170 s Boston,MA 02116 i i • I, jl 1 Failure to possess a current edition'of the Massachusetts Not valid without signature State Building Code is cause for revocation of this-license. ` MASS.GOV/DPS DPS Licensing information visit: WWIN. L ACORO® CERTIFICATE OF LIABILITY INSURANCE FDATE(MM/DD/YYYY) 12/27/2017 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: and Gray Processing ROGERS&GRAY INSURANCE AGENCY INC P"C"0 508 398-7980 FAc No: E-MAIL ADDRESS: mail@rogersgray.com 434 ROUTE 134 INSURERS AFFORDING COVERAGE NAIC# SOUTH DENNIS MA 02660 INSURERA: AMGUARD INSURANCE CO 42390 INSURED INSURER B: CAPIZZI HOME IMPROVEMENT INC INSURERC: INSURER D: 1645 NEWT'OWN ROAD INSURER E: COTUIT MA 02635 INSURERF: COVERAGES CERTIFICATE NUMBER: 225463 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUER POLICPOLICY NUMBER MMIDDY EFF POLICMM/DDY EXP LIMITS LTR COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE DOCCUR PREMISES Ea occurrence $ MED EXP Any oneperson) $ N/A PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY JECT El LOC PRODUCTS-COMP/OPAGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED N/A BODILY INJURY(Per accident) $ AUTOS NUTOS ON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE WA AGGREGATE $ DED I I RETENTION$ $ WORKERS COM PEN SATION PER OTH- AND EMPLOYERS'LIABILITY YIN /� STATUTE I I ER ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 A OFFICER/MEMBEREXCLUDED? WA WA NIA R2WC863728 12/25/2017 12/25/2018 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEd$ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 N/A DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,maybe attached if more space is required) Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay claims for benefits to employees in states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this certificate was issued(unless the expiration date on the above policy precedes the issue date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at www.mass.gov/lwd/workers-compensation/investigations/. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Daniel Cr ey,CPCU,Vice President—Residual Market—WCRIBMA @ 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD CAPIHOM=01 CLEI)DUKE A�o�zozD' CERTIFICATE OF LIABILITY INSURANCE DATE 06,2812017Y) 06/2812017 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED.--BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed, It SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsements. CONTACT PRODUCER UP CT &Gray Insurance Agency,Inc. A Ext: aC No:(877 816-2156 434 Rte 134 E-MAIL ro South Dennis,MA 02660 DD mail ersra .com s: @ g g INSURER(SI AFFORDING COVERAGE NAIL K INSURERA:Arbella Protection Insurance.Company,Inc. 41360 INSURED INSURERB: Capizzi Home Improvement,Inc. INSURERC: Capizzi Enterprises,Inc. 1645 Newtown Road INsuRERD: Cotuit,MA 02635 INSURERE: INSURER F COVERAGES CERTIFICATE NUMBER REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE AIDDp UBDR POLICY NUMBER POLIO OLIC EFF PY EXP LIMITS A X COMMERCIALGENERALLJABILTTY EACHOCCURRENCE E 1,00D,000 CLAIMS-MADE rX OCCUR 8500067380 06/0812017 06/08/2018 DAMAGE TORENTED 500,000 MED EXP(Any one person) 10,000 PERSONAL&ADVINJU $ 1,000,000 GENL AGGREGATE LIMIT APPUESTER: GENERAL AGGREGATE 2,000,000 POLICY a LOC PRODUCTS-COMP/OPAGG $ 21000,000 S OTHER' COMBINEDSINGLELIMIT 1,000,000 A AUTOMOBILE LIABILWY a ANY AUTO 1020064960 06/08/2017 06/08/2018 BODILY INJURY Perperson) $ OWNED N SCHEDULED AUTOS ONLY OS BODILY INJURY(Per accident) 3 AUUTNONLY X AIR D ONLY AUTOS PROeE�R�YDDAMAGE $ 5 A X UMBRELLA LIAB X OCCUR EACHOCCURRENCE g 2,000,000 EXCESS LIAB CLAIMS-MADE 4600067381 06/08/2017 06/08/2018 AGGREGATE $ 21000,000 DED I X I RETENTION$ 10,000 S WORKERS COMPENSATION PER EB AND EMPLOYERS'LIABILrrY ANY PRROR//PMMRIETOERR/PARTNER/EXECUTIVE — EL EACH ACCIDENT S IWFI taryiV% EXCLUDED? NIA E.L.DISEASE-EA EMPLOYE 5 If yes,descllbe under DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD lal,Additional Remarks Schedule,may be attached if more space is required) WORK'COMP CERTIFICATE TO BE ISSUED DIRECTLY BY THE CARRIER CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Evidence of Insurance ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE 7 ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD I The Commonwealth of Massachusetts Department of Industrial Accidents` Office of Investigations 600 Washington Street Boston,MA 02111 wn,mmass.go Idia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Capi22i Home Improvement, Inc. Address: 1645 Newtown Road City/State/Zip: Cotuit; MA 02635 Phone#: 508-428-4613 Are you an employer?Check the appropriate box: Type of project(required): 1. ✓ I am a employer with '40 4. 1 am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. New construction 2. 1 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' 9. Building addition [No workers' comp.insurance comp.insurance x required.] 5• We are a corporation and its 10. Electrical repairs or additions 3. I am a homeowner doing all work officers have exercised their 11. Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12. repairs C o � insurance required.]t c. 152, §1(4),and we have no employees. [No workers' 13. Other J*041 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. =Contractor that check this box must attached an additional sheet showing the name of the sub-contractors and state whether br.not hose entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number.j y I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: AMGUARD INSURANCE COMPANY/NAIC#42390 Policy#or Self-ins.Lic.#: R2WC775326 Expiration Date: 12/25/2017 Job Site Address: 3 f r C-e.AC, f 4 City/State/Zip: w -15k,(e r//ri¢-1,x 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 t 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 a surance coverage verification. _— I do hereby certify u er the pains d penal ' perjury that the information provided above is true and correc Sip-nature: Date: Phone#: 508-428-9518 Official use only. Do write in this area,to be completed by city or town officiaL City or Town: by # 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#: °pIME r Town of Barnstable *Permit 4 � 1 �t. Expires months from issue Ante Regulatory Services Fee Y 9BARNsr'A , ESS PEI`4.MTTomas F. Geiler, Director Op s639. Aim rFD MP't APR 2 1 2009 Building Division TOWN F I Tom Perry, CBO, Building Commissioner BARN Q STA EMain Street, Hyannis, MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number) I �_ Property Address P_<csidential Value of Wor G ���� Minimum fee of$25.00 for work under$6000.00 Owner's Name & Address /%IyW6— ;P S'd�6�/ p®y Contractor's Name �NQl2G F �/g M poc) Telephone Number I lome Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: ❑ I-ama sole proprietor ® I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name _ Workman's Comp, Policy # Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) M Ite-roof(stripping old shingles) All construction debris will be taken to GA)jjJ >F4�--L ❑ Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders. U-Value (maximum .44) 'Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. 'Note: Property Owner must sign Property.Owner Letter of Permission. I copy of the Home Im rovement Contractors License is required. SIGNATURE. ).'N 1'1-II.I:S\Pt)IZMS\building permit forms\EXPRESS.doc ' Revised 100608 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations' 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le 'bl NaIIle.(Business/.Organization/Individual): RAJ De R A , FOU �Ad'dres4;�7 �' a�3 t`2— S �C-ity/State-q. 56Iz rug-r413 Uf M,+B zd 4 hone.#: ✓�a8 ���- �' g d� Are you an employer?Check the appropriate box: Type of project(required): L❑ I am a employer with 4. ❑ I am a general contractor and I 6 ❑New construction employees(full and/or part.time).* have hired the sub-contractors ..2:❑ I am a'sole proprietor or partner-' listed on the attached sheet 7. .❑Remodeling ship and have no employees These sub-contractors have g.'❑Demolition working for me in any capacity. employees and have workers' 9 ❑Building addition [No workers'-comp.-insurance comp. insurance.$ required.] 5. ❑ We are a corporation and•its 10.❑ Electrical repairs or additions --�er_do-- -ing--- r officers have exercised their 1 LE]Plumbing repairs or additions a_homeown all wok §152 myself[No-workers'-comp. right of exemption per MGL 12T[ o`of repairs , 1(4),and we have no - - -� - insurance required:]'t---�---� c. 13.❑ Other employees. [No workers' comp.insurance required.] *Any applicant$rat 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 subcontractors have amployers,they must providt:their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.M 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;tip 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 MA for insurance coverage verification. I do hereby certi u er the par -and enaldes ofperjury that the information provided above is true and correct � e Phone#: Official use only. Do not write in this area,to be completed by city or town officiaL City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health '2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of 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 foregoingg-engag in a tom •enterp�nse�d.m10ffig—the leg-a-represen-fatWee3r6f-rdemased.empioyer,or-the:.. receiver or tiustee of an individual,partnership, association or other legal entity,employing employees.'However the owner of a dwelling house having not.more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced-acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152,§25C(7)states'Neither the commonwealth nor any of its political subdivisions shall . enter into any contract for,the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and, if necessary,supply sub-contiactor(s)name(s),addresses)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 of1. rcJ, a C_—_.—_.1— G11tT....e..tin4YV �+ e M� fnt t unn rPoarrtina the.apnlirast, the aiuuaVu AUL you LU LLll Vl1L 111 Lille t Yl LIL Wu WA.LA-va ua�wub -��•- -p--o— a- Please be sure to fill in the permitflicense 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 ne4v 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-dank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call The Department's address, telephone-and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel. # 617-727-49-00 ext-406 or 1-877-MAS-SAFE Fax# 617-727-7749 Revised 11-22-06 • www.mass-gov/dia i tTo�ti Town of Barnstable Regulatory Services & 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 Property Owner Must Complete and Sign This Section If Using-ABuilder as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application for. -(Address of Job) Signature of Owner Date - Print Name If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the-reverse s ide. A.V^D t!C`.l Tl MTV 0 DCD%LTf+['1l11.1 Town of Barnstable Regulatory Services uttxstest.e. Thomas F.Geiler,Director Building Division PlF° � Tom Perry,Building Commissioner .200-Mairi.-Stree Hya=ds;MA-026fl 1 R w.town.barnstable-ma.us Office: 508-862-4038 Fax: 508-790-6230 HOTD;OWNER LICENSE EXEMPTION Please Print 2f- ®� JOB LOCATION: J 7.6 Cr C— 9 � r t ° 13/9 ' A.)s �7 L number street village Alto �y "'HOMEOWNER": Alto pe— ' t �/9 1M PCU S 09, 36 2 6D !L9 3 >/4 P-?L� _ name home phone# work phone# CURRENT MAILING ADDRESS: f��X d� d cityhown 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 r supervisor. DEFINITION OF HOMEOWNER Persons)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 Cods and other applicable codes,bylaws,rules and regulations. The undersigned."homeowner"certifies thathe/she understands the Town of Bn=table,Buildiug Depart rent r331n1 U inspection procedures and requirements and that he/she will comply with said procedures and rcgw•r nG Signature of Homeowner Approval of Building Official Note: Throe-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 ID9.1.1 -Liceruing of construction Supervisors);provided that if the homeowner engages a persons)for hire to do such jwork,that such Homeowner shall ad as supervisor." Many homeowners who use this exemption are unaware that they arc assuming the respansbrlitics of a supervisor(set 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 unlier-0 persons In this case,our Board cannot proceed against the unlicrosed person as it would with a licensed Supmvisar. The homeowner acting as Supervisor it ultimately responsible. To ensure that the homeowner is fully aware of his/her msponn'bilitics,many communities require,as part of the permit application, that the homeowner certify that hUshe understands the responstbilitics 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 sucb a form/certifrcation.for use in your corrmrunity. Q:fmmu:homccxcmpt I Application:to:. Old King's Highway Regional Hisjoric District Committee in the Town of Barnstable for a r CERTIFICATION.OF EXEMPTION Application is hereby made, in triplicate,for the issuance of a certificate of exemption under Section 6 and 7 of Chapter 470, Acts and Resolves pi Massachusetts, 1973, as amended for proposed work as described below and on plans,drawings,or photo- graphs accompanying this application. 7 TYPE OR PRINT LEGIBLY DATE ADDRESS OF PROPOSED WORK :3, 5 �� l/ L ASSESSORS MAP NO. OWNER �' �DU ASSESSORS LOT NO. HOME ADDRESS ,3 7 TEL. NO. SD d 3 �'� �9 C)� AGENT OR CONTRACTOR T ADDRESS TEL. NO. This application is for exemption of proposed exterior construction on the ground that: ❑ (1) It will not be visible from any way or public place. (2) It is within a category declared entitled to exemption by Old King's Highway Regional Historic District Commission. (Check applicable box) PROPOSED WORK: Describe and furnish plan of proposed work, showing location on lot,and, if an addition Is involved,show, ing location of existing building. •, SIGNED 4� - Owner.Contractor-A nt Space below line for Committee use. . Received by H.D.C. The C ificate' 6y Date Time By Date le, Approved The categories of work entitled to exemption are listed on DisaDDroved the back of this form. Application to: 0P °E° Old Kings Highway Region al''His uric District Committee in the Town of Barnstable for a r CERTIFICATION.OF EXEMPTION Application is hereby made, in triplicate,for the issuance of a certificate of exemption under Section 6 and 7 of Chapter 470, Acts and Resolves of Massachusetts, 1973, as amended for proposed work as described below and on plans,drawings,or photo- graphs accompanying this application. . -7 TYPE OR PRINT LEGIBLY DATE ADDRESS OF PROPOSED WORK . 3 ASSESSORS MAP NO. 1131 OWNER �-' / ASSESSORS LOT NO. �O Z HOME ADDRESS 7 TEL. NO. SO 0 3 /`Z 6�`I AGENT OR CONTRACTOR r ADDRESS TEL.NO, This application is for exemption of proposed exterior construction on the ground that: ❑ (1) It will not be visible from any way or public place. ~ [� (2) It is within a category declared entitled to exemption by Old King's Highway Regional Historic District Commission. (Check applicable box) PROPOSED WORK: Describe and furnish plan of proposed work, showing location on lot,and, if an addition Is involved, show• ing location of existing building. j2 L 4 1'/ 11S OF /3,�9 2-1 rcL 02 G / (mac= SIGNED -. Owner•Contractor-A nt Space below line for Committee use. . Received by H.D.C. The C ificate' Pby ril 1.Ir— Date J � Time By Date le, Approved L The categories of work entitled to exemptlon are listed on t P Disapproved ❑ the.back of this form. a Town of Barnstable *Permit# �6d7'7O I ��1FIB Tp�,. Expuea 6 months from issue date _ l - �� .R - - ervi ces .... __ -- . Fee-• - -� ThomasF--Geiler,Director - ��,. . : -Building'Divisivn- Fan Building Commissioner •200 Main.Street,-Hyannis,MA 02601--••• OR 4 20®J office: 508-862-4038 „ - A Fax:'508-79�0-6230' . .. -.....__ .:<• .... ONLV N Qr g� .. -• " XP S EY21GtTT PIGIC113DON - RESIDENTIAL Not Valid withoutRedX--Press Imprint Mapiparcel Number l Z7 property Address ~j© Minimum fee of$25.00 for work under$6000.00 ❑Residential Value of Work _ A Owner's Name&Address �v©mac= '. r4oL- F0 Telephone Numbery � Contractor's Name Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: ❑ I am.a sole proprietor I am the Homeowner I have Worker's Compensation'Insurance �t Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate'must be on file. permit Request(check box) ❑ Re-roof(stripping old shingles) All construction debris will be taken to ❑Re-roof(not stripping. Going over existing layers of roof) 1�S i Re-side o i= r3 R aZ NJ — [.,i k t; Fo F2 L i le-C= ❑ Replacement Windows. U Value ( •4 ) *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i-e-Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. Home vem Contractors License is required . . Signature � Q:Forms:expmtrg Revise063004 v' Town of Barnstable Regulatory Services 9 m� Thomas F.Geiler,Director Building Division TomTerrh Building Commissioner 200 Main Street, $y=is,MA 02601 www.town Barnstable;mams Fax: 509-790-6230 Office: 508-862-4038 Property owner Must Complete and Sign'? Ms Section If Using ABuilder as Qwner of the subject property to.act on mybeh-X, 'hereby authorize: in Z�.tters relative to work authorized bytlL bung pew application for, (pddress of Job} Date Signature of Owner Print I*tame • -- ___ The Commonwealth of Massachusetts Workers' Department of Industrial Accidents Office atlnuesdgadons 600 Washington Street, 7h FloorBoston;Mass. 02111 Com ensation Insurance Affidavit:Building/Plumbing/Electrical Contractors name• AA)00Cl— l7AMPoy address 375'r;�D fj 02- S7 �JO1C�o �� state: /11h zip: O 6F phone# ->O�� 3 work site location full address): 5 C Dd� S•T 09 S #13 L& 0 Z6.6 I am a homeowner performing all work myself. Project Type: ❑New Construction❑Remodel "I am a sole proprietor-and-have no one working in any capacity. ❑Building Addition ,eer 9t Oc- ° g&)efu o ❑ I am an employer providing workers' compensation for,my employees working on this job. s`rY.t'.i j'av�b�: 1.;t F�.. ,..✓q.�: � ..� ,Af( _ >�• 'A J frh•...4}:��.,y'�"¢'�r?' 't` l s+;. „•a:• a:.:.r.i, ::9t: vF,.1 .,f• .:t�� x �Wt t eorri �n a rile:Z•:.e.. ,.sn:.tr:.�ss�'rs:."t..r�a .�. r.•.Y,A:.,,:,,•.:.Gx <:, ..s:.:,.c..,a,,.!•....y ... :�.,K:y a>'�M1 fr.3'S`'_:"^,,2-s:�s;.•'!ta,^q�Ssrt-3'`E Y4' e � .G iy,W:y '+s *r4yry,•�.. � w ,, - s 72•.��.fift '�ari'i ti� :-s,D,�e^ r ..•.L 2s iL�.�A��a'✓ a < r J t s r s �` `�� 4ti a....F u a.�'k.xz 1N"�3rx'•�+'" � i 3 ,�'�r�r:wr'%ii-'�•c Jy:} �iV�N` �� t4 i �„�,441 s: � �.l- ... ,`r . :a�di"eS$ se+ •r :?fi,c a�a ,t�fF +�a m .<tXS2;� wA' , TCl rr, t r .............................. ". "p01"�ier✓" u.3 A - r Iw...l M1bilT->„�Irs+"eay7,Y3.•.p` ,+,� ?r-$ 'Js' : `'t'�. .M� .`.. 0 YY �Ly t fY v.,,go�yt(t L h..✓�C T� ss._F ,ri4 msLrance�tea .:. �o.?,`$...�. °b?4a I am a sole proprietor,general contractor,Jr bomeowne (circle one)and have hired the contractors listed below who have hfollowtn workers' s compensation polices: %<x 2 :.r„ s�::,�,n;• �:�• F. r,'1.v�•:xn3:�r.:.`'.Y.f.'.,c.- Scq �'' ,r E.. com an 1t►ame - ? :a .r r. , r.. x: :,. �.:.. ,_t'?:...:. �.,., ...�.a.,b_,:,.. ,_.....,.d,. � <, ..:,.,:�.�.:.:>.: ohc:#:..:'.•::"; y(�� '•�i.� -'S.. ��-sue I, n lc, .: rr 3 is x: v K c {> :., :...,.rL�._:vx,4,,.,,.._...,..:...:.......i,t:ti..�f:.ts-_.•._:.•:..r._s.w.- :iw 1:....:.1.Y?.....,,.-b - r s: - Y: 7 - 'eity � a T .'L 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. I do hereby c der the p ' nd p aides of perjury that the information provided above is true and correct Signature Date 3— / Print name A) 2L' 1P Sri^A Phone# 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 El check if immediate response is required ❑Selectmen's Office ❑Health Department contact person: phone#; ❑Other (revised Sept 2003) tY `, c ' Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the"law", an employee is defined as every person in the service of another under any contract of hire,express or implied,oral or written. An employer is defined as an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer, or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a . dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer. MGL chapter 152 section 25 also states that every state or local licensing agency shall with 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 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 may be 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 Investigations 600 Washington Street,71h Floor Boston,Ma. 02111 fax#: (617)727-7749 phone#: (617)727-4900 ext. 406 r-��--- � 4(� � 1-� Engineering Dept. (3rd floor) Map Parcel O42 =Permit# a2 13�f House# 3 7:6— ,-Date Issued -.313/�q'7 " Board of Health(3rd floor)(8:15 -9:30/1:00-4:30) C C�d� 0 Fee �'7,/UP .J 0 Conservation Office(4th floor)(8:30- 9:30/1:00-2:00) INE - - 19 , BARNSMBU. TOWN OF BARNSTAELE Building Permit Application Project Street Address Village G[>C-,<Z Owner Ao()ag- a zf c,/L-7 C X SA P4 Po o -;Address �- Telephone O 3 r- Permit Request 25 E,1CT47-it1 D 4 X1 S C, EN CL 0 pope,- v /D � Ro or- d, S/t:;�c S,o i,.,U6[,6:-S wHi i 0- /'/2��j J -5�,,9Z-L P�►-iU� CJ/.C��DGc) S .Dp o I Z D`/D//r�T� l0 /�D/�T�/ �l�L , First Floor /�� /cj Z' square feet Second Floor square feet / Construction Type 0060 �o4.)S i LUC Ti D A C.,LC--t P26pF' S eezS < tzT,6�,�c,,5 � y Estimated Project Cost $ %O —/S, o ez�o ii Zoning District /L l= Flood Plain C Water Protection Lot Size :j 3? .4c_ Grandfathered ❑Yes ❑No Dwelling Type: Single Family 14 Two Family Q Multi-Family(#units) Age of Existing Structure 2 L© S Historic House M/Yes Q No On Old King's Highway ❑Yes Q No Basement Type: A)Full tA Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) 4-5 0 !=r y Number of Baths: Full: Existing New Half: Existing New No. of Bedrooms: Existing t? New Total Room Count(not including baths): Existing 7 New First Floor Room Count Heat Type and Fuel: ❑Gas 4 Oil ❑Electric ❑Other Central Air ❑Yes S No Fireplaces: Existing New Existing wood/coal stove JQ Yes ❑No - r Garage: 19 Detached(size) 2. ) Other Detached Structures: ❑Pool(size) c� ❑Attached(size) 2)Barn(size) laic 4 d ❑None C6 Shed(size) %O X /!;- W Other(size) k Z Z, Zoning Board of Appeals Authorization Q Appeal# Recorded❑ Commercial Q Yes ®No If yes, site plan review# - Current Use GW i� {vGC� -�r9C(L /o(�E{ Proposed Use Builder Information Name Telephone Number Address License# 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 CONSTRUCTI�OND7 RESULTING FROM THIS PROJECT WILL BE TAKEN TO �2 SIGNATURE DATE/ — 3 _ BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S) F FOR OFFICIAL USE ONLY y, PERMIT NO. ; DATE ISSUED r; MAP/PARCEL N* ` ADDRESS 'VILLAGE OWNER N i-+ DATE OF INSPECTION: FOUNDATION r M ' - Q v FRAME 7 = / . ' J INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL _ PLUMBING: ROUGH FINAL a GAS: ROUGH FINAL FINAL BUILDING 7 b-) r DATE CLOSED OUT ASSOCIATION PLAN NO. I. r:,.f4�...:�� 'M n�.r,;�f*.�.,-.,-,G it r�:,;f..�..+`n r, tY4 YyjV:��^�-•.-�.:-yy...L-..tiT��",c"�"'ti'`�r ,J'l.. F1ME Tp� The Town of Barnstable SARNSTABU.MASS. Department of Health Safety and Environmental Services p 0 039. �0 Building in Division o� 367 Main Street,Hyannis,MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissioner Inspection Correction Notice Type of Inspection Location � � Permit Number —[ Owner Builder One notice to remain on jobsite, one notice on file in Building Department.. The following items need correcting: ` � a At IV er `5 trk l PC-WcL Please call: 508-790-6227 for re-inspection. Inspected by �iU �}�M ��► Dates 6 a i 1 WE . "'�. The Town of Barnstable .. • 13MINSTA1314 9� Department of Health Safety and Environmental Services 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: JP©P.ry 1J jFx-rexi Si c At Est.Cost Address of Work:' 6r-e-i SZia-( 4-6— Owner's Name ? A/U Da-e7- P EGS(G 0 _:5 /qw f 0 U ,Date of Permit Application: I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job under$1,000. Building not owner-occupied Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: Date ' Contractor Name J Registration No.� OR -Date Owner's?Name The Cannnonwealth of I fassachusctl:v •ri f.�.:- Department of Inditstrial Accidents i VMCCollavesllgatlons \�iiii• Y•;�, 600 11'ashht,;;ton Street Bo sron. Jfasx (12111 Workers' Compensation Insurance Affidavit A1)rlic�tnt information• _.._ ......_. POse PRINT Iebi)Iv , •t name• f /' A-)�21� � Si9`IL I PO y Sit)' 1-4 �0 6,9 nhnnc 1 am a homeowner performing all work myself. [I I am a sole proprietor and have no one working in any capacity [1 I am an emplover providing workers' compensation for my employees working on this job. cmm11•rm• n•rmc• ;rddres�• cin•• nhnnc�• insurance cn noiicv tt - �(� I am a sole proprietor. ,encral contractor. homeolvne (circle arc) and have hired the contractors listed below who n ft the following workers' compensation polices: cemnan%- n•rrnc! 1AJ C tdrlrctc I-f©LL ,�RP-� �2/21a nhnnc it• 6/7 ?7 Q 21-4® /p in-mrinrc en 4- LrvlfC?/�( /ILJ� Co cmmrian%• n:[rncr ' add resc- city• nhnnc its i2ur-ince co policy 0 Attach additional Sheet if neecssa •-- 4•r_^T7,.--J,--:vas u.. `.ram_ v...•_�.: - �r v: 1"•`��yyiie:.'.':""w...-� Failure ter secure,ctn•erat;c:rs required under Section 3A of 51GL 152 can lead to the imposition of criminal penalties of aline up to SI.500.00 andiu. vne ycarn'imprisonment ns well as civil penalties in the form of a STOP WORK ORDER and a fine of S100.00 a day against me. 1 understand that cam,'if this statement may be forwarded to the OfrIce of Investigations of the DIA for coverage verification. I tlo herehr cart' in • t/te 'is a d p allies of pci7uty tha 1 info t' n provided above is true and correct. 3 / - p7 $igtlalUtC / zx ate t Print name O Phone .S-4 --?aZ- l�d '�nfficial if. do uni) do not)write in this•area to be completed by city or town otTicial permit/license it r-ttluilding Department ❑Li city or town: censing lluard C • Jelectmen's Uflicc ►-• check if immediate response is required ❑ rr i' �rt_.u[, t)enwrtmen[ L� � J information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation employees. As quoted loom the "1a��". an cvnpluree is defined as every person in the service of another under contract of hire, express or implied. oral or written. An ctttplt rer is defined as an individual_ partnership, association. corporation or other legal entity. or anv two the foregoing enLaged in a joint enterprise.and including the legal representatives of a deceased employer.or receiver or trustee of an individual , partnership. association or other legal entity, employing employees. How owner of a dwelling house having not more than three apartments and who resides therein. or the occupant of i d%%--clling house of another who employs persons to do maintenance , construction or repair work on such dwel or on the :rounds or building appurtenant thereto shall not because of such employment be deemed to be an er MGL chapter 152 section =5 also states that even• state or local licensing agency shall .withhold the issunnc renewal of a license or permit to operate a business or to construct buildings in the commonwealth for si applicant who Itas not produced acceptable evidence of compliance with the insurance coverage requircu Additionally, neither the commonwealth nor any of its political subdivisions shall enter into any contract for th performance of public work until acceptable evidence of compliance with the insurance requirements of this cf., been presented to the contracting authority. Applicants Please fill in the workers' compensation affidavit completely, by checking the box that applies to your situatio supplying: company names. address and phone numbers 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. 71 affidavit should be returned to the city or town that the application for the permit or license is being requested. not tite Department of Industrial Accidents. Should you have an}I questions regarding the "law"or if you are re to obtain a workers' compensation policy. please call the Department at the number listed below. City or rowns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bo the affidavit for you to fiil out in the event the Office of Investigations has to contact you regarding the applican be sure to fill in the permit/license number which will be used as a reference number. The at may be get: the Department by mail or FAX unless other arrangements have been made. The Office of Investi=ations would like to thank }you in advance for you cooperation and should you have any qt please do not hesitate to give us a czll. The Department's address. telephone and fax number. The Commonwealth Of Massachusetts Department of Industrial Accidents Office[if Investigations 600 Washington Street Boston. Ma. 02111 TOWN OF BARNSTABLE BUILDING DEPARTMENT HOMEOWNER. LICENSE EXEMPTION Please print. (DATE ' JOB. LOCATION76— C`!j`z w 0- - Number Street address Section of town "HOMEOWNER" De fA �A iM POO 50Y3(,1 6o�d 3 _ Name Home phone Work phone . - PRESENT MAILING ADDRESS �9 D 24 09F 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 such homeowners to engage an in- dividual for hire who does not possess a license, provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER: Person(sj who owns a parcel of land on which he/she resides or intends to re- side, 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 Officia on a form acceptable to the Building Official, that he/she shall be responsibl for all such work performed under the building ermit. (Section 109. 1. 1) The undersigned "homeowner" assumes ..responsibility for compliance with the Sta Building Code -and other applicable codes, by-laws, 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 w• said nzained s and require nte is HOMEOWNER'S SIGNATURE- ` APPROVAL OF BUILDING OFFICIAL Note: Three family dwellings 35, 000 cubic feet, or larger, will be required to comply with State Building Code Section 127. 0, Construction Control. • 1 HOME OWNER'S EXEMPTION The code state that: "Any Home Owner 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 Home Owner engages a person (s) for hire to do such work, that such Home Owner shall act as supervisor. " Many Home Owners who use 'this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix 0, Rules and Regulations for licensing Construction' Supervisors, Section 2.15) . This lack of awarenes often results in serious problems, particularly when the Home Owner hires unlicensed persons. In this case our. Board cannot proceed against the inlicensed person as it would with licensed Supervisor. The Home " wner-' actin as supervisor is ultimately responsible. To ensure that the Home Owner is fully aware of his/her responsibilities, man communities. require, as part of the permit application, that the Home Owner 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 to amend and adopt such a form/certification for use in your community. EAWMAIL s r r I nA /I /1/1111A M A - 4 1 rS M ca Luc, STu A S iC t o. c . r Linri) A-��d Al w�z�� ' va�.tfG fl,19g�'GM6ArI FL-66R SI B T�tc�lV� The Town of Barnstable ci2�s _S^gcrlo t Department of Health Safety and Environmental Services Building Division P •- i► ' � S � t •�\ i I �' ' � � f 4 r• �I t �; \ c• n t i I� f �. ..� �.. i � ' ,� - j _ _ y �j � �� - - -� - -- .. � � � f1I i i L--- ,� ��, - - � '�� � o '�,\ :c ��� .� �. � � �� y � :� y c , � �, � � J, � � .. �. . � �, --- x Io Ft4D -t CB FND S 20 -46 1.75' -21' E 183.73' '� S�nfG 171.98' ; WAYS ; TOWN E i93.87 NNOEFINEo S ,0�"2i'-p90 EXIST13WELLING mom m`I CEppA �" BARN cn . gpR a aZ � i N • C ' DRILL HOLE v ^ F► SET Lu / N LOT 3 Lu SHEDS n; m .o 209, 225 t/- s. f. Ll -co y (4. 8 ac.) ROBERT A. SCANDURRA et ux N MAN MDE POND \ DEED BK. 3003 PG. 297 � I J • � O CB Fr10 E 3-00.00. n, o p9 r E / 30."21 " IV3p."2 i "09 ZOO 00' t95.De,, A' o O LOT 4 m 57, 539 1/ s. f. 0. , z EXIST. ROGER n DWELLING S.N = 15.0 ROAD � Z• w v BA40 TOLL WN WAY) i C O r ti TEMP TURN-AROUND CHICKEN COOP DRIL L j HOLE BONNIE MCNALLY FND I DEED BK. 2387 PG. 66 N 15'-35'-11' W 200.69' DRILL HOLE FND ip � Q 127.87' y 1 N 15'-00'-22' F, 4 �, 1 N/.F RUTH K. CAmPBEL L et a1 ~ "t h+ r r TOWN UNUEFINEo s ............... CEppA FOR REGISTRY USE ONLY BARNSTABLE PLANNING BOARD APPROVAL UNDER THE SUBDIVISION ROBERT A. SCANDURRA et ux .CONTROL LAW NOT REQUIRED. NAN MADE POND DATE DEED BK. 3003 PG. 297 r: 1 ; 10 . 300.00. w 24_ \ o � S 30.- A NO DETERMINATION AS .TO COMPLIANCE WITH THE o S 14� ZONING ORDINANCE AEOUIREMENTS HAS BEEN MADE OR IS INTENDED BY THE ABOVE ENDORSEMENT. N \ �:►E/ a zA \ -o yco N � I CERTIFY THAT THIS PLAN WAS MADE IN N x ACCORDANCE WITH REGISTRY OF DEEDS REGULATIONS EFFECTIVE JANUARY 1, 1976. i a ROAD W BARNHIL� \ AANE H. OJALA R.L.S. ; ' TOWN WAY) � .. .. DATE (q0 ' J \ TEMP / TURN-AROUND BONNIE MCNALLY DEED BK. 2387 PG. 66 down cape engineering, inc CIVIL ENGINEERS LAND SURVEYORS 939 MAIN ST . YARMOUTH. MASS. 02675 1 N 15'-0.87' ry' 1 1 93-513 A% D r 9TF 64 Q O� 6; 3 FND nfCC-t CB FND g 20'-46' ,Vol -2f 8, 183. ;f.75' < r 9 171.9 a '9T�c !93'81, EXIST ti 1 v CHU'9Ciy'S r ONELLING0 6 Cm (m ,Cq Q . in 8� AAA LOCUS MAP SCALE 10 = 2000 ' Q BARNSTABLE ASSESSORS: MAP 131 PCL 62 a MAP 108 PCL 27 DRILL tc to ZONE CLASSIFICATION: RF HOLE SET\�._ " LLJ r LLJ MIN. LOT AREA: 43, 560 S. f. LOT 3 SHEDS I I;, ;U MIN. LOT FRONIAGE: 150 ft. 209, 225 t/- s. f. N MIN. YARD SETBACKS: FRONT 30 ft. (4. 8 ac.) ' SIDE/REAR 15 ft. Q TOTAL LOT AREA: 266, 764 s. f. ( 6. 1 ac.) FLOOD ZONE: licit 3 COMM. PNL. 250001 0011 D n i NIF o i0 STEPHEN & JOANNE W. Z WALLACE -. Tt'. -� i n rir• 1 ti �% 08 2.982 PG 290 09 !*NER OF RECORD \ o ' AN0RE F'. �+ ELSIE J. SAMP0!; / • , _ CEDAR ST. a WEST BAPNSTABL.E, MASS. 02E58 G2. E S p2,,3B,1 DEED 5 . 5905 Pu. 28oe- Jf 31• 0 1 Q LOT 4 CO 57, 539 t•!- s. f. NIF (1.3 ar.) ROGER A. & JAN R. ROGERS EXIST• S.N = 15.0 OMELLINS� DB 3393 PG 4 V • o 0 0 ti 0 PLAN OF LAND IN 6q CHICKEN COOP RV I . BARNSTABLE, 14ASS . DRILL FND PREPARED FOR N 15'-35'-f1' W 200.69' DRILL HOLE i FND ANDRE P . ELSIE J . SAMPSU u� a SCALE 1 " = 60 ' 'LINE 2, 1994 60 0 60— 120 180 N/F RUTH K. CAMPBELL et al r • Application to 1996 050 Ems` F Old Kings Highway Regional Historic District Committee in the Town of Barnstable for a CERTIFICATE OF APPROPRIATENESS Application is hereby made, iri 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 Addition ❑ Alteration Indicate type of building: 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). TYPE OR PRINT LEGIBLY DATE ADDRESS OF PROPOSED WORK J Cyr , w. L' (�V1.0 ASSESSORS MAP N0. OWNER R�r�. �ISI� �m ASSESSORS LOT NO. HOME ADDRESS 3 7 S CLdL.r TEL. NO. (�-_rrLoj 03 FULL NAMES AND ADDRESSES OF ABUTTING OWNERS. Include name of adjacent property owners across any public street or way. (Attach additional sheet if necessary): 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). �"A, ' -l o ' ;2�Cfe v►IS 1 on a�F -csfii nc� =gin�l os �or�. - Sa vn 'caasr IIne, - Pec� shIn� (,JG�i.�i'e -FrI;� S1�'1a.G( Fganems{ -&JincooLOS, Door, mooeGQ, id S D Signed A Owner-Contrac r-Agent Space below line for Committee use. Recei-ved"ey-H.D-G._ l Date helC I i ate is her b Da LB y e Approved -. ❑ IMPORTANT:-, If Certificate is.approved, approval is subject to the 10 day appeal period provided in the Act. Disapproved ❑ pr I � I ADDITIONAL INFORMATION FOR MAKING AND FILING AN APPLICATION FOR A CERTIFICATE OF APPROPRIATENESS The four categories for which a Certificate of Appropriateness is required are: (application for demolition or removal is a separate form). 1. EXTERIOR BUILDING CONSTRUCTION (new or existing buildings): An application is required for any exterior of a building to be erected or altered including windows, doors, siding, roof, light etc., that will be visible from any public street, way or public place. The following scale drawings are required in duplicate with application: plot plan (if addition — show existing buildings in outline), floor plan and elevations. Also required are snap shots of existing buildings, where additions or alterations are to be made. No plot plan is required for addition or alteration which does not touch the ground. 2. EXTERIOR PAINTING: An application is required for any portion .of a building, structure or sign to be painted that is visible from a public street, way or public place. Color samples must be attached to these applications. An application is not required when repainting existing colors, changing to white, or using colors approved by the Town Historic District Committee. 3. SIGNS OR BILLBOARDS: An application is required for any sign or billboard to be erected within the District, with the following exceptions: a. Existing signs or billboards on November 27, 1974.shall have until November 27, 1977 to secure an approved Certificate of Appropriateness. b. Temporary signs for use in connection with any official celebration or parade or any charitable drive as long as they are . removed within three days of the event. Certain other temporary signs that the Committee feels does not detract from "t i the Act may be allowed with the prior permission of the Committee. c. Real Estate signs of not more than 3 square feet in area advertising'the sale or rental of thelpremises on which they are erected or displayed. d. A single sign of not more than 1 square foot in area showing the name, occupation or address of the occupant of the _,,..Ny... premises on which they are erected or displayed in a residential zone. 4. STRUCTURE: An application is required to build or alter any structure within the District which is defined by the Act as a combination of materials other than a building, sign or billboard, but including stone walls, flagpoles, hedges, gates, fences, etc. GENERAL REQUIREMENTS 5. Work on projects requiring approval shall not be started until the Certificate of Appropriateness has been filed with the Town Clerk by the Committee. Approval is subject to the 10 day appeal period provided in the Act. 6. No changes shall be made from the original approved specifications without advance approval of the Commission on an amended application filed with the Committee. 7. A separate application must be filed with each project requiring a ,Cert'if icate'of Appropriateness. 8. Under heading of "Detailed Description of Proposed Work" give detailed data,6n such architectural features as: foundation, chimney, siding, roofing, roof pitch, sash and doors, window and door frames,trim;�gutters-leaders, roofing and paint color. 9. Unless application is complete and legible and all material required is supplied, application will not be accepted or acted upon. Copies of the Act establishing the Regional Historic District may be obtained at the Town Hall. 4 l . f G li Town of Barnstable Old King's Highway Historic District Committee SPEC SHEET I FOUNDATION C.) SIDING TYPE- c2-r 0_0 S 11 1,!nj. 1.2 COLOR CHIMNEY TYPE — COLOR —' ROOF MATERIAL e3 eA(kel r- I �G I Q COLOR PITCH C M v_ 6tS Gy 1t (eve 1 r0d)-�- WINDOW e aS C j SIZE TRIM COLOR— DOORS COLOR SHUTTERS �- GUTTERS W O© DECK GARAGE DOORS -�` 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, Q landscape plan and elevation plans, when 0 o applicable. Plot plan need not be "Certified", but should show all structures on the lot to scale. SPECSHT i P- ^Y, M-IOq•ItOF�(,4 t O �� N nr, A'bd y '3.Oo AG �. p 19 y� 0 A I.00AG ' s " t .81 06 L � O `e y m O .J y� Luc ac ay irQV .! K I ►1 / / 44 JL10 I I - r r , ( r I I I i . ' , : I I r I VF LLJ -- II i I I I ! i i T-! ► . -I • ; j I i I I , , Ti- I ! I I i • I �I F-I - ---F i 1 ! I IF t I III f I ! I - ! _ I i i ? TT { I I -i I Lill - 17 t T Assessor's offioe (1st floor): - o`TNETo p /..'.D••.6.42........ SEPTIC SYSTEM MU Assessors ma and lot number ..... .. o Board of Health (3rd floor): -� m5 f0TM ON STALLED IN COMP _ Sewage Permit number ..... ................. .. WITH TITLE 5 Basa�a LE,........ . Engineering Department (3rd floor): a a �Qp ,tb}9• 0� House number .................................... ..32.5�.....�'��. .. f��'YI� 9�®NI�IJENTa4L C® mara� APPLICATIONS PROCESSED 8:30-9:30 A.M. and 1:00-2:00- P.M..only- TOWN `� �����'��� �"' TOWN OF BARNSTABLE BUILDING . INSPECTOR APPLICATION FOR PERMIT TO Z.-A.05-7 U. ..C.— ......pam .................................................................... TYPEOF CONSTRUCTION .... .................................................................................................................... + ..................... .•..............196._ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location SIT.............................. . ..... .......... ...... ... .......................................................................................................... Proposed Use ..... .d r 2 2...bS ............................................................................. ? .................... ........ 1...�3. 'D �M ZoningDistrict ............................................c............................Fire District .............................................................................. Name of Owner 1 .- LE...1`V!'!:AA. Dl.. .... R Q1. 719. ' ...........Address �...�. � � ........��€�. /U.... .Z. Name of Builder .. S !'`.....................Address . ...... Lfj'. m.6 ... Nameof Architect ..................................................................Address .................................................................................... Numberof Ro_o s ..................................................................Foundation '.............................................................................. Exterior Q 10 5 ..N............. !. G� .....................Roofing ...k Vm...................................................... Floors ......................................................................................Interior .................................................................................... Heating ...................................................................................Plumbing ................. Fireplace ..................................................................................Approximate Cost ......(O.t b8-tD......... ...,.... ........................... Definitive Plan Approved by Planning Board ------_-------------------------19-------- . Area .... . Diagram of Lot and Building with Dimensions �O?� 19e 7 Fee ............................................. SUBJECT TO APPROVAL OF BOARD OF HEALTH l 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. Namei................ .................................... Construction Supervisor's license ........ .. Sampou, Andre & Elsie 30727 dormer No ................. Permit for .................................... 375 Cedar Street Location ................................................................ West Barnstable . ........ ........ . . .... . . Andre & Elsie Samdou Owner .................................................................. Type of Construction .....................frame..................... ............. Plot ............................ Lot ................................ Permit Granted ............PU.. ...............19 87 Date of Inspection ............................ .......19 Date Completed ......19 uq Assessor's offioe (1st floor). o`THETo Assessor's map and lot number ....../.�.��-... /) .; :....... Q� �♦ Board of Health (3rd floor): Sewage Permit number ... .. '?5..�? ... BAaayTsnLE, �--- - rasa Engineering Department (3rd floor): 'ao r House number • 7 (.......!`?l//.l?.. '°�039.A, APPLICATIONS PROCESSED 8:30-9:30 A.M. and 1:00-2:00 P.M. only TOWN OF BARNSTABLE ;BUILDING INS A� PECTORT APPLICATION FOR PERMIT TO .. 1. 1�sj2. 1.C?'.......LPOR, lE-g...................................................................... TYPEOF CONSTRUCTION .... .................................................................................................................... .....................:. ..............19k e)- TO THE INSPECTOR OF BUILDINGS: , The undersigned hereby applies for a permit according to the following information: Location ...��?. ...(.,....co!t( ... 'T.:.... .�t.,�� .........(..K,J................................................................................................... Proposed Use .... r(1 J ....................................................................... .:........... �. .. I J ZoningDistrict .....................................................................'.Fire District ................................................................. Name of Owner .: .1nP'—•-y.6��� ... 0n� Address ...?.� �Jl 1. ...�..............al.'rnRio,., Name of Builder .. ..I.�crr-oFr1 /.-sN.1�.� /.!J................ Address ..1.6...6a, .../ Aj.... ..................... Nameof Architect .......:..........................................................Address .................................................................................... Number'of Rooms ..................................................................Foundation Exterior .........Wo.0a �t'"�l,/td..C1 ......Roofing ...�..�. Floors ......................................................................................Interior ..................................................................................... Heating ............................................:.....................................Plumbing ......................................................................... Fireplace ..................................................................................Approximate Cost .......lc..)... nc)...:-77�.. e�G Definitive Plan Approved by Planning Board ---------------------_----------19-------- . Area �I/.C�../!15=. ............:..... Diagram of Lot and Building with Dimensionse� ��� �9� �. Fee ............................................. SUBJECT TO APPROVAL OF BOARD OF HEALTH - I t 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. • r . Name .�I,'ri1`� ,t?-+...J�TF1.:?�. (' :F...�.. ............................ Construction Supervisor's License ..b. -�:y....l. ............... Samdou, Andre & Elsie A=131-062 No ...30727... Pern-iit for ............dormer ........... .......... .. .................. ....................................................... 375 Cedar Street Location ..................................................... .......... West Barnstable ............................................................................... Owner Andre & Elsie Samdou ........................................................ Type of Construction ...........f.r.a.me2.................... ........................................ ................................ Plot ............................ Lot ................................ Permit Granted .........M......ay...1....1:..................19 87 Date of Inspection ....................................19 Date Completed ......................................19