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UPC 12543 No NASTINGS,MN .� ...I - .... ,. � �^'=..a "1fV C^ i i IFfT ssltE OFF — S,C' r/a' ✓ iti �07/09 i �d �/tCKts �OK/ZG`L�lai G. tr ' TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map %o l Parcel o%1-k Application # ®��� C✓V Health Division f"; _J1 P!'i 3: ` Date Issued Conservation Division Application Fee Planning Dept. Permit Fee 'r 1;'Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address -4 S`- Village Owner Zo 3�ZZ o se. zZ Address . A i> �a , t z- ♦1��.� Telephone s c% • 3 ce2 - B a S ♦., A Q"�;p.�` a Permit Request c.ZYa. Z Z p.1 , o a s 4 " C_Q` ` �L.bSt T� e�«+ L��� ♦ C Z �'WsZ�..— w�c Zc7 C.r�..���„�O'.+ �jA♦L. Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuationl—z.W ee .Ga Construction Type Lot Size / Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ . Multi-Family (# units) i Age of Existing Structure C06% . Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full r6 raw I ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing Z_ new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing *_new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size —Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name _C.cseZ Telephone Number Address License # s a.-�.... ..�.._ o► o s.��� Home Improvement Contractor# N-A\ L- t Email Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE c; FOR OFFICIAL USE'ONLY ` - APPLICATION# DATE ISSUED MAP/PARCEL N0. s ADDRESS VILLAGE OWNER: DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL E GAS: ROUGH FINAL 'FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. - t I Massachusettp -Department of PubliC$afety Board of Build ng Regulations and$tandartas t:..ntitruruin.`'ip.n i�� rSpcciFilt± icense:CSSL-10Z778/ CONOR D M 39 SIASCONSE J).RIS! r¢ s SAGAMOR> BICQZS62 rtsr�mi stoner 08M9/Z018. A f~�1J(?4�r/Jl(Ifr 1(f('I!/�r�i�' �(✓tflf'�/1F'��` .. .. .. - Office of Consumer Affairs&Business R ulatioa License or registration valid for individul use only ME IMPROVEMENT CONTRACTORbefortthe expiration date. If found return to: ' T oplstration: 171251 I Type: Office of Consumer Affairs and Business Regulation 'T zpiration: .311t2016 Parir ership 10 Park Finn-Suite 5170 Boston,MA 02116 CON-SERVE ENERGY CONOR MCINERNEY 376 ROUTE 130 SUITE C SANDWICH,MA 02563 lladersetory Not valid without signature i esrrre.ea N e I Ire sales rewum cm any I nc%�crt I eriL;a i c riuLumm. IMPORTANT:If the certificate holder Is an ADDITIONAL INSURED,the pollcy(les)must be endorsed.If SUBROGATION IS WAIVED,subject to the teffnr and gpIrWitions of the policy,certain policies may quire an endorsement.A statement on this certificate does not confer righte to the certificate holder in lieu of such endorsements. PRODUCER CONTACT NAME CS$SIWORKCOMPONE PHONE FAX A/C,No,Exl: I(AIC.No- PO BOX 946580 EMAIL ADDRESS: Maitland,FL 32794-6680 INSURERS AFFORDING COVERAGE NAIC# 1-877-724-2669 INSURER A: � y Continental CasualtyCompany 20443 DSURED INSURER B: CONSERViSION ENERGY INSURER C: 376 ROUTE 130 INSURER D: SU)TE C INSURER E: SANDWICH,MA 02563 INSURER F: COVERAGES CERTIFICATE NUMBER: I REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BFLOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDINGANY 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. RM ADDL SUBR I POUCY EFF POLICY EXP LTR TYPE OF INSURANCE NbR POLCY NUMBEq MIDD MIDD umTS A GENERAL LIABILITY Y 6011316335 03111/15 03/11/16 EACH OCCURRENCE 11000,000 COMMERCIAL GENERAL LIABILITY DAMAGE I.E�;D.� = 300,000 CJ ABAS LCE ©OCCUR MED EXP(Any me Person) : 10,000 PERSONAL al:ADV INJURY : 1,000,000 GENERAL AGGREGATE s 2,000,000 GENL AGGREGATE LIMIT APPLES PER: PRODUCTS-COMPIOP AGO s 2 000 000 POLICY El r X LAC COMBINED SINGLE LIMIT A AUTOMOBILEUABILRY 6011316335 03111MS 03111116 (Eaaccidend) $ 1,000,000 ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per aWdent) AUTOS AUTOS PROPERTY xHIRED AUTOS /� AUTO S (PAL se d n►DAMACiE NON-OVVNb q X UMBRELLAUAH X OCCUR 601131635 03111/16 03/11/16 EACH OCCURRENCE 2,000,000 EXCESSCLAIMS4NADE AGGREGATE Z000,080 DEDIXI RETENTION f 10,000WWORIMR = mA AD EMPLOYERS'LAB YrtN 6011316341 03111/15 03/11/16 X TORY LIMITS ER ANY PROPRETORIPARTNERIEXEctj V EL.EACH ACCIDENT SOO QOO OFFlCERIMEMBEREXCLUDED? NIA (Panda my In NH) EL DISEASE-EA EMPLOYEE $ 500,00() If ye&descrbe under DESCRIPTION OF OPERATIONS blow EL DISEASE-POLICY LIMIT S 500.000 OTHER TORY LIMITS ER E.L.EACH ACCIDENT $ EI..DISEASE-EA EMPLOYEE _ E.L.DISEASE-POLICY LIINIT Certificate Holder Is added as an additional Insured as provided In the blanket additional Insured endorsement as it pertains to work being performed by named Insured under written contra INCLUDES PRIMARY AND NON-CONTRIBUTORY CERTIFICATE HOLDER CANCELLATION Rise Engineering SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELNERED IN 1341 Elmwood Ave ACCORDANCE WITH THE POLICY PROVISIONS. Cranston,R102910 AUTHORIZED REPRESENTATIVE i L 01988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010105) The ACORD name and Ingo are registered marks of ACORD 1 I I 1 f The Conn nonweam of Massachusetts DePartfient of Industrial Accidents Once of Investigadons 64 10 Washington Street Boston,MA 02111 www.tnass:gov/dYa Workers' Compensadon Insurance davit: Builders/Contractors/Electricians/Plumbers A lic form d Please Print L SWb Name(BusincwOrganizanott/tnd v;ci,a4: Cons rVision Energy Inc Address: 378 Route 130 City/State/Zip: SAndvAch, MA 02563 phone#: 508-833-8384 Are you an employer?Check the appropriate bo ; I.E] I am a employer wide Type of project(required): 6 4. ❑ I am a general contractor and I employees(fi l and/or part-time).' ve hired the subcontractors 6. ❑New construction 2.111 am a sole proprietor or partner- jfiftdon the attached sheet, 7. ❑Remodeling ship and have no employees am sub-contractors have g, ❑Demolition working for rue in any capacity. toyees and have workers' [No workers'comp. insurance c mp•inauranee.t 9. Q Building addition 3.❑ required:] 5. ❑ e are a corporation and its 10.Q Electrical repairs or additions I am a homeowner doing all work o ficefs have exercised their 11. Plumbing repairs or additions myself.[No workers'comp. ri t of exemption 12.0 Roof repairs ¢1 insurance required.]t c. 152, 0),and we have no 3a.❑ 1 am a homeowner acting as a ei iployces.[No workers, 13.[3 Other Weatherization general contractor(refer to#4) 1 .instuamce required] f�Y aDPff�t clot cbecb box N I moat also jW out the stains be showing ebeir watim,oomph fey iotarmatioa Hernmwoma who UONWt Chia affidavit indicating they am doing work and that lute outside eon tCoatraeoors that check this box must attached a additional sheet tenants mmt subaut a nm affidavit indicating suet. employees it the tatb aontractcrs have I the name of the amcosaaccon and state Nrtus�or not those entities have 1oY�•they cast Drop they wotkena comp.Polley ether. �an enrploysr that is pnovltlifirg ed w 'conrpe n W xrwwe for trey em#oyeea. Below is the Polley aced Job site Insurance Company Name: CS&S/WORKCOMP NE Policy#or Self-ins. Lic.#: 6011316349 Expiration Date: 3-11-2016 Job Site Address; City/State/Zip: Attach a copy of the workers'compensation policy floe page(showing the Failure to secure covers as g potl!t`y number and exptratioe date). ge required under Section 25 of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to S 1.500.00 and/or one-year imprisonment,as ell as civil penalties in the form of a STOP WORK ORDER and a fine of up to S250.00 a der t�e-vio . Be advised t a ropy of this statement may be forwarded to the Office of Investigations o e DIA for insurance coy ge verific Ition. If do bye the polies and par of p that alit brio prow"abow h fte and comM Phcmo O,0'[eta!rate silk Do not wrha In tufts are%to be cotpleted by chy�of town offleMt City or Town: Permit/License# Issuing Authority(eirele one): 1.Board of Heath 2.Building Department 3.CI own Clerk 4. Electrical Inspector S.Plumbing Inspector 6.Other Contact Person• Phone#- .ti i 0ORN � II OWNERAU TIRPRIZATION f Gr Of PM"ny kx*Aed at ysS A � on r:=rk on my pmMpy. nm, , on MY beharto min a bUldtng pemi#tD 0wrw sio �oF1KE Teti Town of Barnstable *per Expires 6 monthsfrom issue dote Regulatory Services Fee EARNSTABLE, Thomas F.Geiler,Director v y Mass. i639• ,.�� Building Division TFD MAt J/(/ Tom Perry,CBO, Building Commissioner 200 Main Street,-Hyannis,MA 62601 www.town.bamstable.nia.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number. Property Address Residential Value of Work /D Minimum fee of$25.00 for work under$6000.00 Owner's Name&Addres's Contractor's Name (J J� Telephone Number 3Z3 D l. Home Improvement Contractor License#(if applicable) ❑Workman's Compensation Insurance C ck one: /I am a sole proprietor ®PRESS PERMIT I am the Homeowner ❑ I have Worker's Compensation Insurance gJAN 15 2009 Insurance Company Name ✓V A C, rowN OF BARN TABLE Workman's Comp. Policy# Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) Li 14 /"012-, L1IZ6- Re-roof(stripping old shingles) All construction debris will be taken to /❑Re-roof(not stripping. Going over existing layers of roof) Re-side Replacement Windows/doors/sliders.U-Value (maximum.44) 10//77 aY5 t *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Hist ric,Consep��tion,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. N. A copy of the Ho a Improvement Contractors License is required. SIGNATURE: PO i�l Q:\WPFILESWORMS\building permit forms\EXPRESS.doc Revise020108 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations- 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): t Address: D.�p�G //y� /�Ir7�lyl' 1� / City/State/Zip: Phone.#:^<61_Y Are you an employer?Check the appropriate box: Type of project(required): L❑ I am a employer with 4. ❑ 1 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.t required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 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.❑Roof repairs insurance required.] t c. 152,§1(4),and we have no employees. [No workers' 13.❑ Other comp.insurance required] Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the subcontractors and state whether or not those entities have employees. If the subcontractors havo 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: s I/ 6'e- Policy#or Self-ins. 'Liic.M Expiration Date: Job Site Address: �/S �G��/>♦'� City/State/Zip: a), eAv7d• f G • �j LG 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 inposition 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 DIA for ins ee covera er fica 'on: I do hereby certify unde pains- s o ury that the information provided above is true and correct Si e: -.- Date: Phone Official use only. Do not write in this area,tb be completed by city or town offu:ial. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their.employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more - of the foregoing-engaged in join--en iise�—mc7u�n`g:tlie legal-represen�a�ti zf-nde asedzmpio urthe-:_-.__.._.._:.__:.:-- ..-.. receiver or trustee of an individual,partnership,association or other legal entity,employing employees.-However the owner of a dwelling house having not.more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states`Neither the commonwealth nor any of its political subdivisions shall . enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and, if necessary,supply sub-contiactor(s)name(s),address(es)and.phone number(s)along with their certificate(s)of insurance. Limited Liability Companies'(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete'and printed legibly..The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permittlicense number which will be used as a reference number. In addition,an applicant that must submit multiple permittlicense applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in - (city or town).".A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call The Department's address,telephone-and fax number: The Commonwealth of Massachusetts Department of lndustrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel. # 617-727-4900 ext-406 or 1-977-MASSAFE Fax#617-727-7749 i.. Revised 1 i-22-06 www.mass-govldia tra4ti Town of Barn-stable Regulatory Services • aearrs ELY, • KAM g, Thomas F. Geiler,Director 16 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 I, !.�►'�i''L.� , as Owner of the subject property hereby authorize 1/1/ 1S ��'� -y� to act on my behalf, in all matters relative to work authorized by this building permit application for: -( dress of Job) JWre Yof Owner Date Print Name If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. Q:FORMS:O WNERPERMISSION Town of Barnstable Regulatory Services t t Thomas F. Geiler,Director Mwss . �'PrFni.•`� Building Division Tom Perry,Building Commissioner ......... ....:................_._...__... .......... - -_...._...200 Main-Slreet;-Hyaimis,-MA 026-01 _....... ..._....... ......._.... _._..._ ..:_. www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOl\'IEOWNER LICENSE EXEMPTION Please Print DATE: p JOB LOCATION: DI /� lip° number street village "HOMEOWNER': u�D -77 Vdp� -06 name home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINMON 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 in.Teqtkpn procedures and requirements and that he/she will comply with said procedures and r e en Signa ' o 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 stairs 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 -Ucensing 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 homcowncrs 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 A Duld with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her msponnbilides,many communities require,as part of the permit application, that the homeowner certify that helshe 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 amrnd and adopt such a fomJcertification.for use in your community. Q:forms:homeexempt i I y 1 Board of Building Regulation and Standards Construction Supervisor.License License: CS 14501 ' Birth dW •8/23/1950 i Tr# 1'894 - Ezpiraf on: :9123/2009 . ' .'` 'Restriction: 00 STURGIS STPETER ' PO BOX 372 Y BARNSTABLE,.MA 026,30_ Commissioner M 4" Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registration:. 100390 Expiration: 6/16/2010 Tr# 269584 . . Type:;Individual STURGIS ST.PETER Sturgis"St.Peter 65 Cindy Lane/P.O.Box 372 . Administrator Barnstable,MA 02630 VIM— lb 44 Wm 17,77 �1 la. a t t • Owl F3' c I t��► I 12 / 09 / 200 . 1Oy : 03 r- O v ,W - r- « ! a II ' + j � s � a i `��� `red}'� i`�d'' t�•,��rq ����� :�� t. ,. t;:, Sy��*y �� •'�� '!� j ,'�! p���'R E� ;�' e ��� j � art r ! � ��yAi -r• I `s �► ;t l p�v � t r,. I r • na i i I I i i I �¢fo 1 � �•;t,4 �• 1 S"�;{+F}�ti�ty � �' � i ti"Sr� r' ,.� � n -a.=@•.•� y�. al e ` .mot.„w�; :•i��S�,,��'y �1t�Y•:•y: 4•,�u � !�j��4�f�� �j(�i, �� x,� ` ;�� ' A 3. �a i s i I r— j r i I i \� �, `' ' `_ L / ���• -_ I , .a p� I+ t ,•�� ,,��tip �^, ,J � ' .� � '�'k��, • .� r t 1, •` 1 � ' -'• ,l i � �:_� I ( 1 �T�1rrYi.�_ ,> , M c - ly r r 7 9, '1 •q i1 I � ac,l"� •� �, r, r� �� �' ko 'lot "Ii r i-t i '.x� �^• t' it? H �•« r _ R{-��` r._' I �"/' "P�: ~�`� I >W�µ& r 1�f- ��'t��.�'���fi V. PF 1/0 i . . i, • t:i r� a� � f� ;• Tow n of Barnstable *Permit# . �° Regulatory Services s6171 rssuedare BARwrABLE, Thomas F. Geiler, Director 7 MASS. �p 1639. � Building Division , Tom Perry,CBO, Building Commissioner I� 200 Main Street, Hyannis, MA 02601 I" www:town.barnstable.ma.us Office: 508-862-4038 Fax'M8-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLSt'. Not Valid without Red.\-Press Imprint Map/parcel Number '-1 Property Address t- �� ( � �' LJ1�ill/ 5�1 6-7 zz Residential Value of Work Minimum fee of$25.00 for work under$6000.00 Owner's Name &Address (� / ��Y:Ur—1 7V Contractor's Name Jr 1<S r, ' y � Telephone Number�-uz_� 3 �� Home Improvement.Contractor License# (if applicable) jDy 57 D _ I ❑Workman's Compensation Insurance Check one: X- RESS PERMIT 10 I am a sole proprietor I am the Homeowner SEP 1 5 ZOOS, ❑ I have Worker's Compensation Insurance Insurance Company.Name /� TOWN OF BARNSTABLE Workman's Comp. Policy# Copy of Insurance Compliance Certificate must be on file. Permit Request(check.box). Re-roof(stripping old shingles) All construction debris will be taken to ❑ Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders.. U-Value (maximum..44) o CJ *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Hi tonic,Cor:vatioR6etc. rri ***Note: Property Owner must sign.Property Owner Letter of Permission. C _ A copy of the )_Tome Improvement Contractors License is required. 6; c-n � SIGNATURE: Q: vp1 [LESTORMSIbuilding permit formsEXPRESS.doc Revise020108 i ,per The Commmonwe"Ith of MassacAusetts Department of Industrial Accidents, Office of Investigations 600 Was-hington Street Bostan, MA 02111 www.mass.gov/dia Workers' Compensation Tnsnrance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le 'bl Name (Business/drganizatlonllndividual): - � '� �� ' Address ,` City/State/Zip: IU l:Ls� 0 ti Phone.#: 5 u/o Z 3 V Are you an employer? Check the appropriate box: NTE] f project(required): 1.❑ I our a employer with 4. [] I am a general contractor and I New construction employees(full andlorport-time).* have hired the shb-contractors 2. I am a sole proprietor or partner- listed on the attached sheet Remodeling ship and have no employees These sub-contractors have g, ❑Demolition worjdng for me in any capac employees and have workers' ity. $ 9. ❑ Building addition . [No workers' comgi.•insranuce romp.insurance. 5 ❑ We are a corporation and its 10.0 Electrical repairs or additions rtgmred .]3.❑ I am a homeowner doing all work officers have exercised their 1L❑Plumbing repairs or additions myself [No workers' comp. rigbt of exemption per MGL 12-❑goof repairs c. IS2, §1(4), and we have no incrrrrnCe required]t employees. [No workers' 13.❑ Other comp. mstuancc required-] `Any applicant that check¢box#1 mmust also fill out the section below sbowing th it workers'compmmfi.on poficy information... t Hmncowoct who submit this a$davit indicafing Hrcy are doing all work•.and then hire outside contractors must submitanew afdavitindir�tirr g such Tcontractors that cbeeV this box must attached an additioma]sbect showing the name of the sub-canters and stall whetha or not thost entif cs have cmployc, If the rub-eonh-aetms have employees,they must providh their workers'eurnp•Pofiey number. I am an employer that is providing workers'compensation insurance for my emptoyees. $'elow is the policy and job site information. Insuianc;.Company Name_ /JCL Policy#or SeLf-ins.Lie.#: Expiration Date: Job Site Address: City/Siatr/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 leail to the imposition of criminal penalties of a fine-dp to 31,500.0o and/or one-year imprisonment; as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to MOM a day against violator. Be cd that a copy of this statcmcrit may be forwarded to the Office of Investi tiaras of the DIA fo c e e v cation I do hereby certzf un ;Cpams-an pe f perjury that the information provided aboveis true and correct — Date: Phone#( �� O fwjzl use only. Do not write in this area, tb be completed by city or town officiaL City or Town: Permit/License# Tssudng Authority(circle one): 1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector 6. Other Phone#. 0p'(HEr Town of Barnstable Regulatory Services �YA.RNSrAUX,� Thomas F. Geiler, Director i61q �� ArF0,,,F,rb Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.barnstable.ma.us Office: 508-862-403 8 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder 1. l , of the subject property . hereby authorizeS3 /s. as ;�6 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 side. r W4 Town of Barnstable of THE rti Regulatory Services iaxNsrwsce Thomas F. Geiler, Director .y MASS_ Building Division Tom Perry,Building Commissioner . 200 Main Street; Hyannis, MA 02601 v%ww,town.barnstable.ma.us Office: S08-862-4038 Fax: SOS-790-6230 HOMEOWi1`ER LICENSE EXEMPTION / Please Print DATE: /0 9 r JOH LOCATION: /iP • 8A-2, number street ® village "HOMEOWNER": YC� GJQ O e name home phone# work phone# I CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was e ended to in ude owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for ii' e who es not possess a license,provided that the owner acts as supervisor. DEFINITION F HOMEOWNER Person(s) who owns a parcel of land on'which he/she r si or intends to reside, on which there is, or is intended to- be, aone or two-family dwelling,attached or detach structu accessory to such use and/or farm structures. A person who constructs more than one home in /dbuilding year period s 11 not be considered a homeowner. Such "homeowner"shall submit to the Building Offi a form accepta e to the Building Official, that he/she shall be responsible for all such work performed underermit. (Sec ' n 109.1.1) ' The undersigned"homeowner"assumes res risibility for compliance with the tate Building Code and other applicable codes, bylaws,rules and regula The undersigned"homeowner"certifies at he/she understands the Town of Barnstable Building Department minimum inspection procedures and r uisements and that he/she will comply with said procedures and requirements. Signature of Homco r Approval of Building Official Note: Three-family d, ellings containing M,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. FIOMEOWNER'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 1o9.1..I -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 aic unaware that they are assuming the responstbilities 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 ease,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 responsibilitics,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilitics 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. �� � LCtd� License or registration valid for individul use only Board of Building,Regulatioh1 and Standards '� - - HOME.IMPROVEMENT CONTRACTOR before the expiration date. If found return to: _ Board of Building Regulations and Standards — Regisstrawon;t 100390 One Ashburton Place Rm 1301 = Expiration-6116/2010 Tr# 269584 . _ _ __ Boston,Ma.02108 c YP Individual ST IRGIS ST.PETER=- C"~'� - •- Sturgis St.Peter '-�,,.•;-=- '' - _ 65 Cindy Lane/P.O.`BOx 37?/� ✓ Not y without signature Barnstable,MA 02630 Administrator. 8 /� PERMITPAYMENT RECEIPT TOWN OF BARNSTABLE BUILDING DEPARTMENT 200 MAIN STREET HYANNIS, MA 02601 DATE: 08/16/06 TIME: 09:26 �, \e -----------------TOTALS----------------- PERMIT $ PAID 28.09 ANT TENDERED: 28.09 ANT APPLIED: 28.09 CHANGE: , .00 APPLICATION NUMBER: 20062530 PAYMENT METH: CASH PAYMENT REF: Town* of Barnstable *Permit#o Q AA_11 d Expires 6 months from issue date Regulatory Services Fee tea° • wst.E. b �e3�. `m$ Thomas F.Ceder,Director Building Division Elbert C Ulshoeffer,Jr. Building Commissioner �E � l 367 Main Street, Hyannis,MA 02601w - '"PRESS pM GII� Office: 508-862-4038 AUG 16 2006 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION.�OWN OF gARNSTA61-E nn /n Not Valid without Red X-Press Imprint Map/parcel Number V v Property Address Lks <�'C residential OR ❑Commercial Value of Work 6 s � Owner's Name&Address Contractor's Name 40e c alcx k167TIL - Telephone Number�� S Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance M�7 Check one: ❑ I am a sole proprietor .1. =wner Co❑ Ihavm pensation Insurance Insurance Company Name �` 6T°4{" Worktnan's Comp.Policy# G N's :3 ? T5 a Permit Request(check box) �Re-roof(stripping old shingles) ❑Re-roof(not stripping. Going over existing layers of roof) , ❑ Re-side ❑ Replacement Windows. U-Valtie (maximum.44) ❑ Other(specify) *Where required: Issuance of this permit does not exempt compliance with other town department regulations.i.e.Historic rvation.etc. Signature' I 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/lElectricians/Pluna)bers Applicant Information Please Print Ueidbl Name (Business/Or ation/lndividual): Address: l � ��� �� l N City/State/Zip: ,J0'6 T?� S 4 W2 �5 Are u an employer? Check the'appropriate box: Type of project(required): 1, I am a employer with 2 4. ❑ I am a general contractor and I 6. ❑ New construction employees (fall and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet t• �• ❑ Remodeling ship and have no employees , These sub-contractors bane S: ❑ Demolition working for mein any capacity. workers' comp.insurance. . g, ❑ Building addition [No workers' gmip.insurance 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions required,] officers have exercised their 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions myself.[No workers' comp, C. 152, §1(4), and we have no 12.E]'Roof repairs insurance required.] t , employees. [No workers' l3 ❑ Other comp. insurance required.] *Any applicant that checks box#lsaust also fill out the section below showing their workers'campensatioa policyinfonnaticw t Homeowners wbo submit this alEdavit indicating they ate doing all work eadthem hire outside contractors must submit anew affidavit iadicaiatg such =Contractors that check this box must attached an additional sheet showing the amne of the sub-contractors and their workers'comp,policy mformatian. lam an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site Information. Insurance Company Name: U j,), ZE Policy#or Self-ins.. Lic. 4: �`L �� O\-1 O2S Expiration Date: t2'Zel cu Job Site Address:t-1 5'3 8 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$1,50000 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 kgainA the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. 1 do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Si a Date: b i b b Phone#: 6O g 775 L4 4 q S 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/Towu Clerk a.Electrical inspector 5.F'lumbing'<rsp.eeror 6. Other Contact Person: Fhone#: JLAAJL V 1 Jlit"v3l V lil "J.1%-a JLAAs7 vl 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,.oial 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 of on'the grounds or building appurtenant thereto shall not because of such employment be deemed to bean 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.1n the comma nwealtb 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 your situation and, if necessary,supply sub-contractors)name(s),address(es) and phone number(s)along with their certificate(s) of insurance. Limited Liability Companies.(LLC)or Limited Liability Partnerships (LLP)with no employees other than the members of 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 conf n atiori of insurance coverage. Also be sure.to sign and date the affidavit. The.affidavit should be retaTued 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 ftu-Id imter fheir 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 ta fill in the permit/license number which will be used as a reference number. In addition;an applicant that mist submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and.under"Job.Site Address"the applicant should write "all locations in _(city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that-a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to bum leaves etc.)said person is NOT required to complete this of idavit The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel;.- 617-727-4900 ent 406 or 1-S77-MASS.CE Fax# 617-727-7749 Revised,5-26-05 w-ww.mass.gov/dia cT�ie Boar o Buiffin* g Regina ioAanCiYardse One.-Ashburton Place - Room 1301 Boston. Massachusetts 02108 Home Improvemeri.tbntractor Registration• Regletratlon: 128957. Type: Individual Expiration: 6/14/2007 Oiiver.Kell r: Oliver Kelly 9 Peregrine,lane S. Yarmouili, MA 02e64 Update Address and return card.Mark reason for change. DPB-CAi a soMoaia.o,otate 0 Address [:3 Renewal(] Employment [] Lost Card. Jola+lgapupry -- 1,99L0 VW'4lnouuoA Long tP 100Z/b4/9 • 1989Z1 :uop�ej8ea a0'1'OMN091N8W1a/►0 1 BWOH opaapuel8 Par suogalallog SalPtiaB Jo peoe Liberty Mutual Group PO Box 7202 Amu J Portsmouth,-NH 03802-7202 m Tetephone(a"653-7993 Fax(603)431-5693 May 25,2006 TOWN OF BARNSTABLE 720 MAIN ST - HYANNIS,MA 02601- 11E: Certificate of Workers Compensation insurance Insured: OLIVER KELLY 9.PEREGRINE LANE SOUTH YARMOUTH,MA 02664 Policy Number. WC2-31S-338804-025 Effective: 1228/Z005 Erpiraticn: 12/282006 Coverage afforded under-Workers Compensation Law of the following state(s): MA 1"mplovers Liabift Bodily Injury By Accident: S 100,000 Each-Accident Bodily Injury by Disease: $ 10000 Each Person Bodily Injury by Disease: S 500,000: Policy Limits As of this dater the above-referenced policyholder is insured by Liberty Mutual Fire Insurance Co under the policy listed above. The insurance afforded by the listed policy is subject to all the terms,exclusions and conditions, and is not altered by any requirement,term or condition of any orother documents with respect to which this certificate may be issued. _ This certificate is issued as a matter of information only and confts no right:upon you,the certificate holder. This certificate is not an insurance policy and does not amend,extend,or alter the coverage afforded by,the policy listed above. If this policy is cancelled before the stated expiration date,Liberty Mutual will endeavu*to notify you of such .cancellation. AUIHU RIZFD R>MMMA!IVE 1;RERTY.MUIUALDANCE GROUP MC,MC&&,$C W1CdbyLUMMTYMUrUALII VRANCEGRAUP as scehin�aanooasisa2wdedbq9WWeoMFWes. . usu cc: Insured:::. _ .. _.,ProduoerofReco�d: O I KELLY SANDPIPER INSURANCE AGENCY INC 9 PEREGRINE LANE' 12 ENTERPRISE RD SOUTH YARMOUTH,MA 02664 HYANNIS;MA 02601 o OLIVER KELLY 9 PEREGRINE LANE SOUTH YARMOUTH : . PH/FAX 508 775 4498 MA. REG.# 128957 . MA 02664 INSURED June 15, 2006 Proposal submitted to Mr. Robert Ashworth of 455 Cedar Street West Barnstable Ma We propose to supply all materials and labor necessary to remove and replace the existing roof at the address above All debris to be removed to town transfer. 8" Aluminum drip edge to be installed on all eaves. Ice and water damage protection membrane to be installed on first three feet of eaves and in all valley areas. Remainder of deck to be covered with#30 felt paper. 30 year limited warranty Architect style shingle.to be installed Bathroom vent pipe boots to be replaced with new. Cobra ridge vent to be installed on entire length of all ridges with hand nailed caps. Protect all walls, windows, decks, plants and shrubs etc. during roof strip Repair Chimney flashing as necessary. Obtaining of town permit. At a total cost of$6850 Payment.Schedule; 30010 with signed contract, balance upon completion. Respectfully submitted, Oliver Kelly Proposal accepted by, Date / Z° /2006 Lt Ass%ssor's map and lot number INE Bpi Sewage Permit number INST SW"C OMM MUIN COM Housenumber .................. ... ................... .......................... W" 4 �i3q EN "MENTAL CODE 1"a. LA TOWN OF B A R N S rfXvB LEE TIONS BUILDING INSPECTOR U�r— -Lo Louse— APPLICATION FOR PERMIT TO ........C;-.9?MnJf.............01.Ce...................................................................... TYPEOF CONSTRUCTION ............ ....... ...................... ....................................................................... ............ TO THE INSPECTOR OP BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ........... ......s .......... . . ............................................................................. Y............ ..................................................................................... Proposed Use ...... !1��........ ....... 1> ZoningDistrict ... ..........Q4 Zoni .... . .-F..................................(...................Fire District ..... ............................................... Name of Owner ....X)C,-.kt. Address .................................................................................... Name of Builder .......-5C2L.VV-,.-f,- . .... ..... . .........................................Address ......................................................... .Name of Architect ..................................................................Address .................................................................................... Number of Rooms Foundation ...... ........... Exterior ........C.10T.6s�.4.A..............................................Roofing ..........Ast........................................ ...................... Fl6ors .....e, 4p( ...................Interior ........ .......................................... .e_- Heating. ..... e-a.t k C, .......................... SOJA!7...............:.....Plumbing ..P..... ............................................................ Fireplace ........ .............................I.......................... ................Approximate Cost .......... Definitive Plan Approved by Planning Board --------------—------------19--------- Area .................................. Diagram of Lot and Building with Dimensions- Fee ............................................. SU JECT TO APPROVAL OF BOARD OF HEALTH I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ...... ................ ........ .......... ..... ............... 4i-/ RON, DENNIS & BARBARA 4 l i4� I 'iJo .2.234.1... Permit for Qn.e...S.tor. .......S.i;.Ig],e...FarUY..Dxel ..i ag.............. #455 Location JaA.t;...5.2 ...Cedar...Stree.t........... W. Barnstable ............................................................................... Owner „Dennis & Barbara Caron..... Frame Type of Construction ° ....................................................................... Plot ............................ Lot ................................ Permit Granted Jul 11 .19 80 c Date of Inspection ............ 1. .:...:19�� 4a a Date Completed ........................1900 y PERMIT REFUSED - �► in - 1 ...... . ..............................,..... 19 N >w7 . ............................................. w �....... .s -� �............................................... ........................................................ . Gf......................................................... z Apprg.'sed ................................................. 19 r ................................ ........................................... ............................................................................... J � CE DF\, S i 1)x 2G� 1..0z'� S c�. CD�n/ 1 C-\1 Ian A . 'co 30 Sra, �1 6 Z).+ 3 f A lPL pls�0 -A S 8 0.15 F o Srl S -(a 17 �$S-"A V 1� 1 L_ O� S2 4 �/+'• h lam. f�.•�., I / G 2 A �onP�`N OF Mq s\\ r � o ARRY T _ ��`o .p No.26575�4) I ILL FSS�ONAI o Nc- Tr\Pad T.,Jv S f�u aa, �- G QlP►V>r t_ C0e' P�W . S taua� I � ST.n. 3lZS— DQ ���CLtavf��'�n Assessor's map and lot number ....... .p.. ......... ... ....... �P�oFtesTo�o Sewage Permit number BAUSTODLE, i House number ...................:(�,`... -`..........._..................... q MAO& �O 1639 �D YPY a. TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO .......4.. F?.!�:���u I V G'��- �t.O U.S.C C .................. ................................................................ TYPE OF CONSTRUCTION?CQ �I+ ` V.... .................1 la ?.,:s............19.�`�:. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a fypermit according to the following information: Location .......... :rt.....,5. ..... e :5...... ........... � .!... >.A.f vt �:(, ..:... Proposed Use .......:. , ,. c ....... ;t 4��.1..........��.,D ...................................................................................... ,... Zoning District ........R..'r. .....................................................Fire District �� �.4.V.V.1................................................. j ` I Name of Owner ....�!,.�.k"-.!n.!�t,�;..�!-.A�c`;hcx,�l'�?...C.....a.f.....ol?..Address :................................................................................... Nameof Builder .......:��QVk.�..-........................................Address .................................................................................... .Name of Architect ..................................................................Address ..............................................................:..................... Number of Rooms Foundation ......:............................................... Exterior ....... ...............................................Roofing AS� Floors )rr?K-A .'E..TIJ:e...................Interior ........... n .. .......................................... IHeating .....Fle,.n., r.?..5:.....::t....S'aI.g.r'............:..:.:...Plumbing ..........r ........................................................... Fireplace Approximate Cost -° Definitive Plan Approved by Planning Board -----------_--___-----------1.9 , Area .......................................... Diagram of Lot and Building with Dimensions Fee ............................................. SUBJECT TO APPROVAL OF BOARD OF HEALTH I hereby agree to conform to all the Rules and Regulations of the-Town of Barnstable regarding the above construction. Name ........+..........:'.'. : ................... :.: ................. =108-14 � � • CARON, DENNIS & BA ARA._._l No .22a4.i... Permit for .One„S.t;q.Y........... .......Sinale...Fami.lY....We.1.1ing........... Location ...�e.dax...S.treet .................We.St..B.ax; babies...................... Owner ....Dennis...& Type of Construction .........Frame.................... ................................................................................ Plot ...................... Lot ................................ Permit-Granted ....:...sTU. VY_....11*...........19 80 Date of Inspection .... ............... ..........19 Date' Completed ....................... ..............19 PERMIT REFUSED ................................................................ 19 /�.. ......... lg Approved ................. 19 .............:.................................................................. ...............................................................................