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HomeMy WebLinkAbout0542 MAIN ST./RTE 6A(W.BARN.) i 1 152 1/3 ORA ESSELTE 10% P„<<r Application to .Pilo �"Y►e:""' O Ill I �� �► 6 Old King's Highway Regional Historic District Committee in the Town of Barnstable for a CERTIFICATE OF APPROPRIATENESS Application is hereby made, id triplicate; for the issuance of a Certificate of Appropriateness under Section 6 of Chapter 470. Acts and Resolves of Massachusetts, 1973, for proposed work as described below and on plans, drawings or photographs accompanying this application for: CHECK CATEGORIES THAT APPLY: 1. Exterior Building Construction: 0 New Building ❑ Addition M Alteration Indicate type of building: 7E [ House ❑ Garage ❑ Commercial ❑ Other 2 Exterior Painting: 3. Signs or Billboards: ❑ New sign ❑ Existing sign g •• ❑ Repainting existing sign 4. Structure: ❑ Fence ❑ Wall ❑ Flagpole ❑ Other (Please read other side for explanation and requirements). TYPE OR PRINT LEGIBLY DATE__ 23 y7 ADDRESS OF PROPOSED WORK 6Y2 MAW S7'. ►N• 3AkfSTA6LF- ASSESSORS MAP NO. 133 OWNER BILL '% KATE ASSESSORS LOT NO. ��LL WDW HOME ADDRESS ShME 7Sq� H�55 � TEL. NO. 3bZ-3e/1 KAM 401 lK FULL NAMES AND ADDRESSES OF ABUTTING OWNERS. Include name of adjacent property owners across any public street or way. (Attach additional sheet if necessary). 0/�zrncs 139Vba,.. 73arreJ f. .BOX -153 W. 1-jRrr►S Ia,G�/,c_ 02��� geebe-�-t 1-hI7G Jr. /LJ. J. 12►ce_ Car 120 r. 5z�h. .tti {-Judi Parent , 51 I,-lneej- W. r rnSrzt �7,6�8 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). .- ��/ace¢_ 3Z" S` c/ G�'Laor- wry, 24„ IZI,)dow . E �j�c�J'l,��c��I� Jj��,,� � Z' l'�s 11 '�' � door pFeri inq onto elus*i;1e deck,. U iJJ1�� 3. �epai%If- exkr1br- •tnm &hite3 no color c . P"I'ot eK r;0r• doors barr7 red • rto CDbr CA e . S• : eshl7tA(¢� i!']OVSE. Civ . mar $lClewA��S) . Signed Owner• ontractor-Agent Space below line for Committee use. R Received-by' R Date The Certificate is hereby Date ` Time 2 r 1.J /CZ '''��• i�r•�� e _ By _ .gLE �LA ?&L"A tiny Approved ❑ IMPOR TAN If Certificate is approved, approval is subject to the 10 day appeal period provided in the Act. Town of Barnstable Old King's Highway Historic District Committee 1 SPEC SHEET FOUNDATION SIDING TYPE (� CP-d�l� Sh�nAC� COLOR CHIMNEY TYPE COLOR I I ROOF MATERIAL COLOR i PITCH I WINDOW C�fMG�rfi SIZE ?,4 I TRIM COLOR JyTe f I DOORS cue'tol'YI f -1"6V-eall WlQ%COLOR_ 641th red fi I SHUTTERS COLOR i GUTTERS DECK , _ I GARAGE DOORS COLOR I SIGNS COLORS FENCE COLOR NOTES: Pill out completely, including measurements and materials/colora to be used. Three copies of this form are required for submittal of an application, along with three copies each of the plot plan, 1 landscape plan and elevation plans, when applicable. Plot plan need not be "Certified" except for new homes, but should show all structures on the lot to scale. SPECSHT • Lo T� .3 LG. 36—//3 R i /34-.. 6L ' V waf c aver cj Zr ZED 11 3' I certify that this property is I located in Flood Hazard Zone C (out- i side the 500 year flood) as identified by the Department of Housing and Urban Development (HUD) . ` CERTIFIED ED PLOT PLAN Date /�v�. ZB J9 e �P%Y a LOCATION EDW \• SCALE u= 5a DATE Reg. ao-s�1'{��`/ PLAN REFERENCEAL � ,vG • •• .`�0� PG: �z3 . . . . . . . . . . . .. . . . . . . . . . . . . . . I certify to its title insurance company I CERTIFY THAT THE that there are no visible encroachments SHOWN ON THIS PLAN 15 LOCATED ON THE GROUND Or easements except as shown and that this AS SHOWN HEREON AND THAT IT CONFORMS TO THE plan was prepared under my immediate SETBACK REQUIREMENTS OF THE TOWN OF WHEN CONSTRUCTED. supervision. 89/?!�!ST�9Bl •... . . . . . DATE /ac..G• ,��j'y� •� S REGISTERED LAND SURV OR p!ilb mdo I it mpg �.� ~Ot�llVd •4q1 � �re , � ..�� MAW OP > /// r/ Y. L A:t. �. t •� virw tia Q' 1p.yb W{ lA - lA�. .111 .'.A,. J ��► r,\ I ' J' ( !• - •`F.�: I C� 6• DE Or Y I - _ �-"�+��/'\+"�t'�v�)�i..w-+�-.r�.-/�^•w+....-+'�'ti"'�'yr.��r.w+.�y.`..�+�+w-.-r.�^..--�..-.`.�.�-/'..-•^.'�..,.�.`-�^.,�..Y"ti'.�'-1...-�•�....1�� ,ram A'ses or' ma and lot number0 �'�..� 1�' L9� P. .. ...... ...../�? SEPTIC SYSTEM IbIUST BE INISTALS ED N p E col�P Sewage Permit number E 96 ATE ......... ......... ..... ............ S`� l T•iy CODE AND 'TOWN �Qyo*TNFro�o a� TOWN- OF BARNS ,TA` • � BJHHSTADLE; i � � ��; \ 9 039.Or• BUILDING INSPECTOR i0�r�MFY �., APPLICATION-,FOR PERMIT TO /'�` .... '� � �� .7Z) .. ` TYPE OF CONSTRUCTIONAr/1� lJ'.L.... L } :� //. ��1� 1 . ............................... TO THE INSPECTOR OF BUILDINGS:, The undersigned hereby applies for a permit according to the following information: Location// �iO�5_ /'���� /�� ��,� ProposedUse ....... >. ... ................................................................./.,.�..................�...........`..�................................ Zoning Dis ri .... ......... -r.. .. ............ . ................. . Fire District f/� ../. ... / f � t � Y ..:............._.................. Nameof Owner ..........................................,..... ...................Addres ',..1_ ..... .. Name of Builder .............................I.......�.....�...�.......�.................Address ... .�.. ....�.. ...............i ..G........... ... /..�.'.�.:.....:..�.Name of Architect � 15e5:d ...........Address ....... ... ........................................................ Number of Rooms ......... ........... ...............Foundation:�� ' T. r " Exienor ....................................................................................Roofing .,����/�?��G�T.... �� ........... c"W//3/ %o/A/ �, 007— Floors .................................`../..................................................Interior ..G- .... f /�/1�.. �, / ems'. ��.fi1 ` �,� r� Heating v G/� � / Plumbing .......... , !1� i� / ...........................:.... ...... ......... ............................... Fireplace ..................../..'/��...................................................Approximate Cost ......;A!. I jUUVr UQ /Q+. ........................ Definitive Plan Approved by Planning Board _____________________________19________. ( Area .......!... ... ,. Diagram of Lot and Building with Dimensions \ e/Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH hereby agree to conform to all the Rules and Regulations of the y,Q01 n of Barnstable regarding the e construction. Name ..... ............ 41...:......................... Booth, George W. & Harriot E. • No ....1,7.22,4.. Permit for ....AM..to•,sin g . ray £ami.�y...dw��.li,r�g......�...1. Location ......tso} ....................................... .....................West...8arus.tabl.e............ ............ Owner ........George..W.,...&.Harri91..E....BGRt + Type of Construction frame.................... ' ................................................................................ Plot ............................ Lot ............................... Permit Granted ........July, 22............ 19 74 July Date Inspection. 9 Date Completed �pJ ...........................19 PERMIT REFUSED " ' ................................................................ 19 � i ............................................................... � ............................................................................... .. } ;......'......... . ........................................ 4 Approved�............................................... 19 f i ........................ .................................................. ................................. e Application to 'hi6it �Qobuap Regional JDigtoric �Digtrict C ee In the Town of Barnstable FES�:. a.tea CERTIFICATE OF APPROPRIATENES ro / 1 3 2404 N�SrpAi oFRA9Ns Application is hereby made, with four complete sets, for the issuance of a Certificate of Appropri Bar Se tion 6 of Chapter 470, Acts and Resolves of Massachusetts, 1973, for proposed work as described below n lans, drawings, or photographs accompanying this application for: CHECK CATEGORIES THAT APPLY: 1. Exterior building construction: ❑ New ❑ Addition ItrAlteration Indicate type of building: House ❑ Garage ❑ Commercial ❑ Other 2. Exterior Painting: ❑ 3. Signs-or Billboards: ❑ New Sign ❑ Existing Sign ❑ Repainting Existing Sign 4. Structure: El Fence El Wall ❑r Flagpole ❑ Other TYPE OR PRINT LEGIBLY: � `Iu J DATE 2' 3 1,9 ADDRESS OF PROPOSED WORK S12, kr A 8AAN5rAr ,,ASSESSOR'S MAP NO. 133 OWNER �' �� n'�-6 N L� ASSESSOR'S LOT NO. b a HOME ADDRESS 5 u{ (,::,'A GV 44 k-&J 5r,+?3 TELEPHONE NO. 3 7S' - b.SS*6 FULL NAMES AND ADDRESSES OF ABUTTING OWNERS, including those of adjacent property owners across any public street or way. (Attach additional sheet if necessary.) AGENT OR CONTRACTOR F �1T� �1/�G- TELEPHONE NO. 51a ADDRESS f Z 3 �1 //� CeVTv17 AA- O0,63 S— DESCRIPTION OF PROPOSED WORK: Give particulars of work to be done, including materials to be used. Please include locations of proposed signs. S�vS TA41— !v'6 s S'/°•4N6'4 ,eC"e-it Dao,4e v.vlT 4ve7154 ,0/0/,oE� Signed Owner ontractor-A nt For Committee Use Only This Certificate is hereby DateLi9V—_ . Approve Committee Members' Signatures: I Town of Barnstable Old King's Highway Historic District Committee SPEC SHEET �O V FOUNDATION FEB V 004 HSroNOF04RNS SIDING TYPE COLOR P Tgg�F r�oN. CHIMNEY TYPE COLOR ROOF MATERIAL COLOR PITCH WINDOWS COLOR SIZE TRIM COLOR �o Ix h �,8 DOORS /hAR-V/Ev — /61 V/A 67,0 616,97 COLORS ieES G G'�"AJ SHUTTERS COLORS GUTTERS COLORS DECKS MATERIALS GARAGE DOORS COLORS SKYLIGHTS SIZE COLORS SIGNS COLORS FENCE COLOR NOTES: Fill out completely, including measurements and, materials/colors to be used. Four copies of this form are required for submittal of an application, along with Four copies.of the plot plan, landscape plan and elevation plans, when applicable. 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F�ij? } <Sr,. e � asd-'I r .4� ��:s er r j �� iiSt�.�-r.z��-�i .S fir; .,r,.,.� _..nut,y}'� - — vf• w; �_ e'�-5a; fri 7�i,y �- � n ._�v�`.�t.s ;� f �r d kl�t � _ r � 83 _ ty � r(V�'�x,�L sE�'� T �Vy-•h �, �F�r i g� �t �'°�`n• �;tt.;�ar�°,;d:�^;.4r 04 MAP 26 PM 2: 1 Application to Oth Ringo ;if bhiap �eytonal 3biotoric 349trict Committee BARNS TABLE TOWN CLERR In the Town of Barnstable CERTIFICATE OF APPROPRIATENES!§ . D Application is hereby made,with four complete sets, for the issuance of a Certificate of App op to l��'¢¢,,s un is i 6 of Chapter 470, Acts and Resolves of Massachusetts, 1973, for proposed work as de trig d bet sp on , drawings, or photographs accompanying this application for: CHECK CATEGORIES THAT APPLY: STO�CA�gRN 00v 1. Exterior buildingconstruction: ❑ New ❑ FSFR��T�OF Addition Alteration N Indicate type of building: [A House ❑ Garage ❑ Commercial ❑ Other .2. Exterior Painting: ❑ 3. Signs or Billboards: ❑ New Sign ❑ Existing Sign ❑ Repainting Existing Sign 4. Structure: ❑ Fence ❑ Wall ❑ Flagpole ❑ Other TYPE OR PRINT LEGIBLY: DATE ADDRESS OF PROPOSED WORK 5*'Y2, RT ;(A B141-mSfi1QL SSESSOR'S MAP NO. l33 OWNER IVUI N L` ASSESSOR'S LOT NO. 6 HOME ADDRESS S LJ L TELEPHONE NO.37S - b sSb FULL NAMES AND ADDRESSES OF ABUTTING OWNERS, including those of adjacent property owners across any public street or way. (Attach additional sheet if necessary.) AGENT OR CONTRACTOR I�ls"tc ���G— TELEP ONE O. '4&- eg E3 ADDRESS DESCRIPTION OF PROPOSED WORK: Give particulars of work to be done, including materials to be used. Please include locations of proposed signs. RED v E d m VO 1,5 `T L/Z T"s rA4Z, A>'4 $ gp4tiF4 v.,,e77 &--Oe7z�o' 40/40/eOEo Vu\ Signed Owner ontractor-A nt For Committee Use Only This Certificate is hereby Date �J Approve eni . Committee Members' Signatures. I Town of Barnstable ` Old King's Highway Historic District Committee SPEC SHEET D FOUNDATION 13 H/SpWN pF ���4 SIDING TYPE COLOR pR/�pRFSFNSTgB RVgT/�� CHIMNEY TYPE COLOR ROOF MATERIAL COLOR PITCH WINDOWS COLOR SIZE TRIM COLOR #/ DOORS A*R-u/A - p/V/AED GI GfIT COLORS j�` G��C^N v SHUTTERS COLORS GUTTERS COLORS DECKS MATERIALS GARAGE DOORS COLORS SKYLIGHTS SIZE COLORS SIGNS COLORS FENCE COLOR NOTES: Fill out completely, including measurements and. materials/colors to be used. Four copies of this form are required for submittal of an application, along with Four copies.of the plot plan, landscape plan and elevation plans, when applicable. 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F- V a Ygia+F f: n '�rr9 s b ,.a ,'�-`!��,'•�f.,.�••ry`.3ro �3siY ,,�q�VS 'S ,� �y^ s�t"a��'i k 4�c'����r t .�„�' �A" dph�,"k.�,d4�r�°�".s .: ��..As i � -`� � �k ice'' yw" '4'Ut r 55-"'' ,�'� k.[r "�Z ;G� �� �f .L 'u�.•C fi'�'r..,..vp5� tr, yr}'h�.i' 7'�s ,s, nJ=�- �- e !s`:.�. a* 1k��i����C h^4e:.,�'Ji-•'}'ne7.'rt .F . ..,r �' �s..�s � w�Ir'_ixe��y � f + -r+i s,� `�' +a -.. f'.kkm�"�`.. 1. �• P,-T� ,5(�''�. °i '*��i''.si'st_. i` xS+s 4' Y4 a.t ;.,*N.._ :,Y.%J 1�' � � ,a.� �'•�..�i.'...._ -s.. ns :.Y�.,.;�°' ..t.a�.K-.a. 5v"�a^�.u�a.. >%. '•,,,�k'.-. �7:,. far...f SS ._ - f c v; 1�:: .^ ti ,ii�Ssi �: � i 1 �'�Z v����/ cv� � f � �crrv�c�—$ ? i �� i TOWN OF BARNSTABLE BUILDING PERMIT APPLICATIONJC` y r Mapes l33 Parcel e2/L�) Permit# S� Health Division —qo l 4Ei> 3Z Date Issued Conservation Division �� Application Fee S cc Tax Collector P Permit Fee Treasurer SEPTIC SYSTEM MUST BE 1�lSTALLED IN OOMPLIANC� Planning Dept. V=ITME S Date Definitive Plan Approved by Planning Board a,", tC ONNIENTAL CODE A"'- Historic-OKH Preservation/Hyannis TOWN REG;U1,1• 1." Project Street Address / j S T Village Owner 13 A-)tL/3A-,P—k FZ� 1 0 Address __ •�y 2 � � /4- Telephone --�D 7 S" 40_fs_;�> Permit Request :T v aZ'.�_ 4(AP_Q/._-1 W U­ /cam G., '",9 w S E r `z /2 �- 40�rpcx�lre_ Square feet: 1st floor: existing proposed -- 2nd floor: existing proposed— Total new '1 Zoning District Flood Plain Groundwater Overlay Project Valuation DU Construction Type FA—,4mE Lot Size Grandfathered: ❑Yes O-No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure IMP f AWHistoric House: ❑Yes ❑No On Old King's Highway: Yes ❑No Basement Type: ❑Full ❑Crawl a kout ❑Other , Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing y- new G Half:existing new Number of Bedrooms: existing new Total Room Count(not including baths): existing new --i5TFirst Floor Room Count �— Heat Type and Fuel: 2-6a_s O Oil ❑ Electric ❑Other Central Air: O Yes ,Erlq—o Fireplaces: Existing Z New Existing wood/coal stove: ❑Yes ,ZKO Detached garage:O existing O new size A*- Pool:❑existing O new size Barn:❑existing ❑new size Attached garage:❑existing ❑new size A-Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# Current Use Proposed Use //�'' BUILDER INFORMATION Name (,6 6�� yw,�— Telephone Number _�L- ^ i34 8 Address_ Z'2-_Y 3 License# © Q GI��40�.3f— Home Improvement Contractor# `/nk Z/ Worker's Compensation# ALL CONSTRUCTIO DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO CAL SIGNATURE W WU DATE 3 2. FOR OFFICIAL USE ONLY PER?*T-NO.. DATE ISSUED 'MAP!PARCEL NO. ' ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME 1 INSULATION <- FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL' FINAL BUILDING Q DATE CLOSED OUT- =ASSOCIATION PLAN NO. 4 ' License: CONSTRUCTION SUPERVISOR ' Number'•'CS 084792 { Birthdate &[21/1946 'Ezpi i-9�02/2! ,07 Tr.no: 84792 Z. wli- _ _- • ; Restfiisted r1G.j. I GEORGE: WING I 1243 MAIN ST COTUIT, MA 02635" ,i Administrator I . ✓� VG�7'2�')L4'ILL//P.2L(.iG O��!(�U.FAdIIA:1I.lWP.�d . Board of.Building Regulations and Standards Lice se.or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR befo a the"expiration date. If found return to: Registration: 140821 •Board of Building Regulations and Standards One�shburton Place Rm 1301 Ezpiration: 11/28/2005 Boston,Ma.02108 Type:. Individual VING I s NING z" A 02635 Administrator Not valid witbvflt signature 1 mot. ,•... � �..'L:, :'r� •.Y, The'Comti�ani eabth gMassachusetts = 1)eparhnent of IndustriatAceidents' 660'Was3:ington Street ; _ Boston,Mass. .,02111 w Workers'..C m ensation usurance Affidavlt-General BusiVERM ne§`sESE M_ es i address: s. v c state �. -. work site locati full address :' ; ' s e. []Retail❑Rest?urant,B`i/ 15n*Fstablisbmeat atn•a sole proprietor and have no one �P '�S'P a Antos etc. []Office[)SaTps(including Rt;al'Est e, in an capacity • yeorking �' eln'lo ees full&' art time): O}her ' %�%%i I am an a, to with ' / %//%/��%////%//%%%%/////////%//%%///////%%%% n this job.. . //yl� cam easation for my employees worlan , zprovidingWL -ere' Pt, .•.• ;rg�r+'.,j t:'`.. ` , , :; ,•t.• •s- ' !' . .t ar�. �7loyer1 `- .. .r.. 1 ..R`. + 1.. '.��,: �' •.1'^,l'':I:Yy^:.}:' ?'••' t• �+��1"�''•i �t .:,��'• .:,+''t' '!•' `.t.r.t.'.t', .f' :' -',•. .5 r. _n ,1 i:•':" ':s. tiS� �(:t'•••' •i'�•":l,ZtiT:' :i!•r •1 - + �;iri.�rl� ,t , ;. .�..•,.. •• '•i••• , .i t' �lil��Nr.•?.S••••t:i'{y'1.••t•ti i:;i. i Yt•'t•,' tit- ,�j•:„•3'' 61 .1 'i' Y t,• •,t J,,,r�2,?a. :(1.",-X. •7j f' ' .. v, •••'•�•. �aa S , t r• r. cork"ari :h•�:�F:z:: ;!:•�+ . . ' :;p'' ;�'6' :i; 6 ' • v, . r 1 {• rt ;v:l+t5'iti.r:tr�•:a+hrt`'rk:.:lt::'�''�t ti a ;o.' 1rt. 6tit 1 1 •'s r•.r.a4t: +�i��3• .'':. sa •.: ..5.':t:r• ? r r y:.:'F.. . .. :tt � .r• ��.,:'a,�,..r1(Q.L++":ii'• - .., .r i rY'v S �i{•. \i i'• '•+�••r sdi3ressi' ,{' "' f.,s'.:. •'r:3•;ti'.': f�•'+>1. i J '' '• .` ?:_•:`� ,,�,. t(.•.;•ti�t !.i.;.: Sly,�ty .v ; r t,' , :i�,•,e.�+.�••••;�•�^•.''. i'"'L'a."xl,'ti 1�;:'t 4i•• { ,, t:'r .+' :'•I �..• i:::�r �' :r. ,+.�. .t � +''r r}, � .' 110I1'e. � ,• � ••• � v F " ^ ��•• .:'.::s'':i'' +: •,� „"?:'. " .St.t�• :li ,1 't i:,•. .... .iF1• }C, •..t::r :•1,::'t.tt• ••, ,;�' t'rb:��f '�~•% '•' '''•' :''•:.,1"+.."; �•:;'ty, :"ht.�.l.ij`l.'�.''•�';.li'1,%w:1k••� 1.• .r •013C'.iF�'t_•1 .p.�b71•' ,C, ' ��/. r rlsuYsr�ce.co:r, "� orkerS' / .' ' am a sole proprietor and'have hired the independent contractors listed below•who have tpie following iv '. + _. • pe asation polices: '•� •�_•, •• ;• . ,�. ' !', .irr Fitiy�•-:i'•{�t�';.�::+:•iifyP4{vr�f!.�'1: ;:�F jy�•��,�-.:? ' 't• • 'r•' •••. r 4 f•Y,y,•r' ••l+•ur )�.. f%.t:'• .!`t.' 1 '• " e i',••f •,..h r�� 'Mi. .:si:'tr+: ', '' t' s:t't�^{�"•i...'�• .�+,. r. .. . . t t.. •r•;..1•r' �P.y.,'1•',•:.��1 Yam;.{• i.{y"�r'; .• ' ' 9D ''i18DaIE<;. r'•:, , a:: 'bi:r.;t;,•. •' t' s ,e:J;°:' t i. y;�r},r �,,:q:„ t � p., , j7�;� .b-�:°.! t.i•ir:''I.�%.'+'' '�?r:t•': '7., ts:`;" t •.i t• + .'!' nl.'. .r. 1��.�u• •'�• •.'. .. r."• •H • i.l,P,_ i4..{t t' •;' ":;t 'r i. +,{i•' :i;v•.�+Itii..�:. Lr. 'r� . :t ti.�•� 'jY',. '�•:• 5 is l•.r,•�•:.'� ', ?• ; .r•:t..'Cr.,.rt r'.Yt.gi:b�,i:',,:-t.5't?.•;•:y.y:.',.•'i'�1;•�,N ,r•�tJ..•+j•'yS's','ri,ts':r.l•.j�.' :.•j'.F,q`..1'•••i, f, i 'G`t v:l•• „•..r..'t .y,�.:.. •:.-'.,-�.+....7{10 8t V,..it,r: hbne .,{.:i`•3..:•.-r r l.:.' • '•:7.t•�`.p.�".,�,•S•'ftr' ,,a•.N:N ;.l, ,,,r,. ;t..t ";!•t ^'�j;.r� �:,•' •.1. `• `, j..,:•: +�. .' + :�i ,, "_ 4"+y'�yt 1.::: +r "r'•.I:t�.•j}•d!i'-'. •i i'�'t�• , '''+1�s��:t . Cr + p •}`:: t�. i •.'•r ' 'a' �f"iYSar "ji.;'tq: �lil:y�tr '."t�'S3 i�r t :�f'' aa•31 ti Ft•� :r: t r,.. .st•t:•:s. .:• ), ,i• :, '•%:'/r •: ,,tl i4• �t 'Y:. ;r:• C Sff:' .r,�i:t y:.:,}t!:.:.'.'•:. •,u' +::=�;a i xa+�!.:: :'i:,t:.• /`olr l%////////G/%//1, 711. im 152 en to the iristutance'ca. / :• o / •• :. r• • (I •� ' •1 ., 1: .i�, , '�• 1.••.A: ; �t+�•: •r•1 ,7'.,,I .. •r ,S• :+, ;':••`.• ii`:1• ji i.,•: ;• , ' t. ''�.n..tii'ttJ`t•'a Y l" !rti":�:'ttcaw•7 °.:... •t :i..+ 1'3 ��'',t•.' t %J y.v'..:'1•�•I.,. r�,5• I•i•Jt5 rJ.v' +i�,., '�.r. S:i r•t'v..t:r�:�•' •'\ I' '.t•i':+'C:' !'Ja .i;•". i. „ .. ntv• ,' "• •',r\.f•p•:y'S'('"'IY:.0 �•�t�jy� •..�"fir• '4:� '•�`•.tt•. Yw•�F''.Y.r....t. •.s i'�" .f .i r; �';: .t; :.1-• 't•, t01n t. , ti.•'i h, , eiidreS ',� •.. .' ;•• :•y �• •.. .r0..'r .r:., «.=F,Irs,, :t;:',• `•.%I���Z'rt%:,.t;twtt '• t:,.,t :•ti,:•li..t, t't'r..ty!.. ', !�•i..�C.-!r' t' �•''� �•.�'•4' <tir.. '•p)•�+•tfl••r i�:i•'.1•• ,e 1. t,tr.. .:'.Yr..':.T�11'af �rf1:•.. :; `, •'!ice,; ., ''• �?..' •a.�'"r.iryt' li ,fr.•1• °' .:i' tiyt .�. >t .. ; Y t•1'K�lf rt T'''•^- ! '1'.i. ...f,y;. „ {�,,•, i.:,..': ���:".'.,:1'a: ,., + •• ',,L. a t •S" .,L'•.,'.M1,y�•, v: ' r'I."'" 'F'"' l''''i� r''• 'Y.•r. :,N't-'t�y':tt e.:'J.i:st�''i .tit.��iu J.a" O71C.':�.• •%y •: insursncdat{�._. allure to secure coverago m req,rlred under Section 75f of STOP WORK ORDE pand a fino ofr 00 04e a�sy aSain,tm°pY uaeretand that} F t ent as well cfvilpensities inth oaeyears impribio . ' copy of this state ent maybe forwarded to the Office of Investigation of the DlAfor coverage verification. I do hereby certi a penalties gpequry that the infonnatzon provided above is f 3e a�d�corracr; Date 5�ignature ., • ' � hone# Ei�Iri print name Official use only do not write in this area to be completed by city or town of7.CW permitilicene# ❑Building Department Clucensing Board city or town ❑SeIeetmenls Office Dvheclt.if immediate response is required C]HealthDepartmenf phone#; []Other contact person: (tevned S*t 2003) , ' Information and 14structions' r eral Laws ch1 ptcr 152 section 25 regdires all em4loyers to provide workers' co, pensatidi�far their Massacliiisetts Ger< ' "`' , employees; quoted'frointhe °law" an employee is.defined as every person m the service of another under any contract of hire,'express or ir*ed; oral or written. i er is defined as an individual emp o3' ,partnership, association, corporation or other legal entity, or any fwo or more of An . the foregoing engag'a.in a�joint enferprise,and including the legal representatives of a deceased,employer, or the receiver or artrrershi association or other legal entity, employing employees. 'Howevei••the owner of a trustee of an individual,P . p' dwelling house hav�S' 0t'tn°re three apartments and resides therein, or the,occupa&bf the:dwelling house b£ another wh°. Pl°j's persons to do main�kenance,construction or repair work on such$welling houae.or on the grounds or buti�g app enact thereto shall notb'ecause of such:employmeut.be'deemed'tobe ari employer.•:.. . r' censin aQeno shall withhold the issuance dr renewal chapter 152 sectabn 25 also'states fhaf every state or legal li g b y MGLtoo operate a business or to construct buildings in the.ibnunonwealth for any applicant who has of a license or permit p not produced acceptable evidence of compliance with the Insurance coverage reiluized: Additionally;neither the' cozranonweal nor any..Of its political subdivisions shall enter into any coutract for the performance of public work unto table evidence of compliance with t�e insurance requirements of this chapter have been presented:to the contracting authority: 0 'INEVEMEEN 1/01 Applicants Please fr ew Cr �s'•eompensa�affidavit completely,by checking the box that applies to your situation,Please supply company name, address and phone numbers along with a certificate of insurance as all affidavits maybe submitted to the Department'of xndustnal Accidents-for confirmation of insurance coverage. Alsobe sure to sign and'date the affidavit. The affidavit should be returned to the city or town that the application for the permit or licens a is being d, not the pepartment o Xndustrial Accidents. Should you have any questions regarding the"la:*;or if you are requeste requixedtorohtain a Wo. =T!.compensationpolicy,please call theDepartaient at the nbipber liste�l.�elovv. , . City or Towns • , Please be sure that the affidavit complete anclprinted legibly. The Department has provided a space at the tiottoni of the affidavit for you to'fill o-at in-the event the Office of Investigations has to contact you regarding the applicant Please b e sure to fill in the p��'•G�a m mmber which wM be used as a reference number. The.affidavits may be returned tQ or FAX unless other'ariangements have been made. the Department b'•� . .. r:. , The Office of Investigations would file to thank you in advance for you cooperation and should you have airy questions, esitate to give us a•caIl. , please do noth The Aept's address,telephone and r. fax number. , The Conurionwealth Of Massachusetts- Deparbnent.of Industrial Acca•dents . �lflce of la�t8stillstlena ' 600 Washington Street Boston,MR. 02111 fax#: (617)727-7749 Town of Barnstable E►o Regulatory Services qa $ Thomas F.Geiler,Director �Ar 1639�k�� Bail ding Division F�Mp Tom perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Fax: 508-790-6230 office: 508-862-4038 Permit no Data AFFIDAVIT OM,ZVROVF MMNT LA- SUPPLEMENT TO ERMITAPPLICATION w L c.142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, MG emhe or construction of an addition to any pre-existing ow1pr-occupied -improvement,removal,d „nits or to structures which are adjacent to b��g containing at least one but not more than four dwelling such residence or building be done by registered contractors,with certain exceptions,along with other requirements, / 0 0 0 �lI f p 0 D W. VP of l v� .�i(/ Fstun�ted Cost - 'type of Wozk �`1, 6 A tv �9 A /r Address of Work: �� Owner's Nam Date of Application I hereby certify that: Registration is not required for the fallowing reason($): ❑Work excluded by law c ❑lob Under$1,000 []Building not owner-occupied []Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OINUROVEMENT WOORRKDGO NOT HiVE CONTRACTORS FOR AYFUCABLE HOME ACCF,SS TO THE A�YTgATION PRO GRAM OR GUARANTX FUND UNDER MGL c.142A. SIGNED ER PENALTIES OF PEPJURY Ihereby apply for apermit as the agept o e o/ er: 'onNo. Contractor Name Registrah Date OR Owner's Name ° jHE,a Town of Barnstable Regulatory Services BnxNST�nei.E. = Thomas F.Geiler,Director 9�A�F 639. � Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Fax: 508-790-6230 office: 508-862-4038 Property Owner Must Complete and Sign This Section If Using ABuilder I, �•- I��C,.- i...+5 , as Owner of the subject property ize to act on my behalf, hereby author in all matters relative to work authorized by this building permit application for. S-Y (Address of Job) / e 2 ao S� Ji&gnature of O�er to Print Name Q:FORMS:0 W NERD ERMIS S ION TOWN OF BARNSTABLE BUILDING PERMIT APPLICATIONk�lel Map � G Parcel l d - - Permit# 7Y-e :�4:�n Health DivisionD2 6 17 '`'' � Date Issued Z9 Conservation Division ! -` 10 Application Fee Tax Collector Permit Fee Treasurer Tow SEPTIC SYSTEM MUST CE; Plannin De t. XNST�.LED IN CO�6PLlAf�C� 11� 9 p TITLE S Date Definitive Plan Approved by Planning Board E^&'i/'1 R01, tYhgEMTAL,=2 P..: Historic-OKH Preservation/Hyannis L 1 Project Street Address 5"`� Z �T A- Village r;!/ BA7)LN 5 T/�/3 LL Owner �L.4Q!J(/N1-- Address ��VZ /P-T 6-4 tt� Telephone ,5_0 8 — S 7,5 — O.S'S'O Permit Request X 6--P rim Square feet: 1 st floor: existing proposed '61�)_2nd floor: existing proposed �— Total new� Zoning District Flood Plain Groundwater Overlay Project Valuation /©,D eO Construction Type W,,d P Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ,Ef'' Two Family O Multi-Family(#units) Age of Existing Structure 13" Historic House: O Yes Etgo- On Old King's Highway:,ADIes 0 No Basement Type: 0 Full ❑Crawl alkout O Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing new — Total Room Count(not including baths): existing 7 new �� First Floor Room Count .— Heat Type and Fuel: atlas ❑Oil ❑Electric ❑Other Central Air: O Yes , EMo Fireplaces: Existing New Existing wood/coal stove: ❑Yes --E Ne-• Detached garage:O existing ❑new size �—Pool:O existing ❑new size_6 Barn:O existing ❑new size Attached garage:O existing O new size Shed:O existing ❑new size` Other: Zoning Board of Appeals Authorization 0 Appeal# Recorded❑ Commercial I]Yes @-N-o— If yes, site plan review# Current Use g5f XT6-la A)wi 17 Xf!E�/,D 6N6-,--_Proposed Use (� M BUILDER INFORMATIONName V L �" Telephone Number l li D Address '^T� (AVM I w LicenseCA, Home Improvement Contractor# _ LI P Worker's Compensation# —` ALL CONSTRUCTIgN,DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO rp SIGNATURE DATE L FOR OFFICIAL USE'ONLY' hERMIT NO. I'r E 'DATE ISSUED- 'MAP/PARCEL NO. ;. Y f q ADDRESS VILLAGE OWNER { DATE OF INSPECTION: FOUNDATION FRAME . .` INSULATION *� FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: _ ROUGH FINAL Tr r -' GAS: ROUGH FINAL' FINAL BUILDING x DATE CLOSED OUT'- ASSOCIATION PLAN NO. 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Geiler,Director Building Division rfD MPy Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 • Fax: 508-790-6230 Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, -improvement,removal,demolition, or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. Type of Estimated Cost 000 Address of Work. Owner's Name: I 1 Date of Application: Z I hereby certify that: Registration is not required for the following reasou(s): MWork excluded by law nJob 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 ELWE 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: Re istratioa No. Date Contractor Name g OR Date Owner's Name °f r � Town of Barnstable Regulatory Services s Thomas F.Geiler,Director 9`�p1i619:�. Building Division _ Tom Perry, Buflding Commissioner 200 Main street, Hyannis,MA 02601 office: 508-8624038 Fax: 508 790-6230 Property Owner Must Complete and Sign This Section If Using A Builder ....... as..Ouinet..of the.subject property_ ........._... .: hereby authorize :. .to_act on my.behalf,. in all matters relative to work authorized-by this building.permit•application for: (Addtes of Job) �o6 tit Signature of Owner Date 4 n-r3 0 ►2 K4 7Q Print Name .,.rnn�Rc•r14JTTF1?PFRMT.CRT(1N RESIDENTIAL BUILDING PERMIT FEES APPLICATION FEE New Buildings,Additions $50.00 Alterations/Renovations $25.00 Building Permit Amendment $25.00 FEE VALUE WORKSHEET NEW LIVING SPACE �—square feet x$96/sq. foot= x.0031= plus from below(if applicable) ALTERATIONS/RENOVATIONS OF EXISTING SPACE square feet x$64/sq. foot= 2 / Sn x.0031= Lb Off plus from below(if applicable) GARAGES(attached&detached) `�— square feet x$32/sq.8.= x.0031= ACCESSORY STRUCTURE>120 sq.ft. >120 sf-500 sf $35.00 >500 sf-750 sf 50.00 >750 sf- 1000 sf 75.00 >1000 sf- 1500 sf 100.00 >1500 sf-Same as new building permit: square feet x$96/sq.foot= x.0031= STAND ALONE PERMITS Open Porch x$30.00= (number) Deck x$30,00= (number) Fireplace/Chimney x$25.00= (number) Inground Swimming Pool $60.00 Above Ground Swimming Pool $25.00 Relocation/Moving $150.00 (plus above if applicable) Permit Fee projcost .L 2-Xro CotlhK T.71e$ ro �-X STI N �j Tv 8 E R E kwo"A S)kUTJNV. S` STEM , W B. �} NSTARl,E MA - _ 7,-oe v Ef — , 44 , 7,Z. �- • "` ✓�BUPKtJ UHF'tS1I�G�REGUL"A 11�7fls i License: CONSTRUCTION SUPERVISOR i Numbed`CS 084792 Bi rthdate: 02/21/1946 'p i Expires. 02/21i20:07 Tr.no: 84792 i � Restricted. 1_G, - r t GEO_RGE-H WING12 1243 MAIN ST ( � COTUIT, MA 02635„.`. - Administrator I i � ;� �J2C "C/JG�7ri%YI20�ZlIM.ILGIiG 6` /(�(.(6AJI/AY/LCQP,�b L + Board of Building Regulations and Standards Lice se:or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR befoi a the expiration date. If found return to: Board of Building Regulations and Standards Registratiori`.. 140821 One{ sbliurton?lace Rtn 1301 Expiration: 1 I/28/2005 Boston,Ma.02108 ;Type:.Iridividual GEORGE WING '-.:,-, I GEORGE WING 1243 MAIN COTUIT,MA 02635 Administrator Not valid witl&ut signature F I i Po,�MEro,ho� The Town of Barnstable BARNSTABM Department of Health Safety and EmTironmental Services Building Division 367 Main Street,Hyannis,MA 02601 -Tice: 508-8624038 Ix: 508.790-6230 PLAN REVIEW Owner: 8R R 8 A R#9 Map/Parcel: 3 - . O 1 O - Project Address: �� M*91 N•sT RTG9 Builder: �3' IC O u/i�N6 W- c e The following items were noted on reviewing: ` /?oo,F S Ne eTN•AJ;. a `L q O. G. /� CI) flz°v,,0e 7� 'e� Decd�s i Reviewed by: Date: I q AFe, 1-4'0V' �3 ., TOWN OF BARNSTABLE BUILDING PERMIT PARCEL ID 133 010 GEOBASE ID 7154 ADDRESS 542 MAIN STREET/RTE 6A ( PHONE (508)362-974 W BARNSTABLE ZIP - LOT BLOCK LOT SIZE DBA DEVELOPMENT DISTRICT WB PERMIT 75552 DESCRIPTION INSTALL GLASS SLIDER, WI�OW REPLACEMENT PERMIT TYPE BMISC TITLE MISCELANEOUS PERMIT CONTRACTORS: WING GEORGE H Department of ARCHITECTS: Regulatory Services TOTAL FEES: $50.00 BOND $.00 Im CONSTRUCTION COSTS $6,000.00 753 MISC. NOT CODED ELSEWHERE 1 PRIVATE • BMWSTABLE, • MAM BBYILDI DLVI�� DATE ISSUED 03/24/2004 EXPIRATION DATE /' TOWN OF BARNSTABLE ' BUILDING PERMIT r PARCEL. ID_133 010 GEOB.ASE ID 7154 . ADDRESS 542 MAIN STREET/RTE 6A ( PHONE (508)362-974 W BARNSTABLE Zip - LOT BLOCK LOT %J,DBA DEVELOPMENT PSTRICT WB PERMIT 75552 DESCRIPTION INSTALL GLASS 'SLIDER, WINDOW REPLACEMENT PERMIT TYPE BMISC � TITLE MISCELANEOUS PERMIT �-� CONTRACTORS: WING GEORGE R - ARCHITECTS: Department Of 0: f.;., - Regulatory Services TOTAL FEES: ' $50.00 -BOND : $.00 CONSTRUCTION ^COSTS $6,000.00 753 MISC_ NOT CODED ELSEWHERE 1 PRIVATE * 01 * BARN9rABM • , " ) BUILDING D ISI N J - BY °DATE' ISSUED 03/24/2004 EXPIRATION DATE ' THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET, ALLEY OR SIDEWALK OR ANY PART THEREOF, EITHER TEMPORARILY OR PERMANENTLY.EN- CROACHMENTS ON PUBLIC PROPERTY,NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE,MUST BE APPROVED BY THE JURISDICTION.STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS.THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. MINIMUM OF FOUR CALL INSPECTIONS REQUIRED FOR ALL CONSTRUCTION WORK: APPROVED PLANS MUST BE RETAINED ON JOB AND WHERE APPLICABLE, SEPARATE 1.FOUNDATIONS OR FOOTINGS THIS CARD KEPT POSTED UNTIL FINAL INSPECTION PERMITS ARE REQUIRED FOR 2. PRIOR TO COVERING STRUCTURAL MEMBERS HAS BEEN MADE.WHERE A CERTIFICATE OF OCCU- (READY TO LATH). PANCY IS REQUIRED,SUCH BUILDING SHALL NOT BE ELECTRICAL,PLUMBING AND MECH- 3.INSULATION. OCCUPIED UNTIL FINAL INSPECTION HAS BEEN-MADE. ANICAL INSTALLATIONS. 4.FINAL INSPECTION BEFORE OCCUPANCY. - -- - POST THIS CARD SO IT IS VISIBLE FROM STREET---_- BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS 1 1 1 2 2 2 I I • I 3 1 HEATING INSPECTION APPROVALS ENGINEERING DEPARTMENT I I I 2 BOARD OF HEALTH OTHER: SITE PLAN REVIEW APPROVAL l 1 g COi1Mtc*in��v?2h rn*°pis°ered conuuM dr :c;.,.,s.,;;t.;.,: _>i, y fund E K SHALL NOT PROCEED UNTIL PERMIT WILL BECOME NULL AND VOID IF CON- INSPECTIONS INDICATED ON THIS NSPECTOR HAS APPROVED THE STRUCTION WORK IS NOT STARTED WITHIN SIX CARD CAN BE ARRANGED FOR BY OUS STAGES OF CONSTRUC- MONTHS OF DATE THE PERMIT IS ISSUED AS TELEPHONE OR WRITTEN NOTIFICA- NOTED ABOVE. TION. I I I I i I I I I I I I I I I I I i I I I I I I I I I I I I I I I I I I I I I I I I I i Ole lVf loolq, i ,. TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION t Map - Parcel Q Permit# 3 �► SA • � t, _,;.4ea1th-DW sion - Date Issued ' �seo' n ivision � � a' Fee Tax Collector z__—Treasurer O dq r -Bate-Defi 'rnhve Pan by Planning Board Historic-OKH 4mh tP.4,1 Preservation/Hyannis Project Street Address s 2-- Village T2-;,-tLb�t'>S-��. Owner Ir( G �t.� ��L� Address '✓44 t Telephone - I Permit Request '►moo 1/)u (,2A fill C G�f , ' S cQ • trf ' [d Square feet: 1 st floor: existing proposed 2nd floor:existing proposed Total new Estimated Project Cost ( Zoning District Flood Plain Groundwater Overlay Construction Type Lot Size Grandfathered: 0 Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family O Multi-Family(#units) i 7 Age of Existing Structure %9�5 Historic House: O Yes ❑No On Old King's Highway:AYes ❑No Basement Type: 0 Full &rCrawl ❑Walkout 0 Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full:existing 7/ 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: AGas ❑Oil ❑ Electric ❑Other Central Air: ❑Yes kNo Fireplaces: Existing New Existing wood/coal stove: ❑Yes VNo Detached garage:0 existing ❑new size Pool:0 existing 0 new size Barn:O existing ❑new size Y Attached garage:O existing O new size Shed:O existing ❑new size Other: Zoning Board of Appeals Authorization 0 Appeal# Recorded O Commercial O Yes `No If yes, site plan review# Current Use O rV,-R— Proposed Use BUILDER INFORMATION Name o 60x� Telep hone Number Address License# Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE • FOR OFFICIAL USE ONLY PERMIT NO. _ DATE ISSUED t MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION. A , i FOUNDATION - FRAME PARTi94 O .S tret Zoo Q0,6 1 1 - INSULATION r FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL - GAS: ROUGH FINAL ^ FINAL BUILDING 4 . 1 DATE CLOSED OUT , -• f 1 ASSOCIATION PLAN NO. �f/o c�9,eA OA/ foB/ Ale Sze-7 The Town of Barnstable •. a�srter • �0�' Department of Health Safety and Environmental Services Eo ' Building Division 367 Main Street,Hyannis MA 02601 Office: 508-862-4038 Ralph Crossen Fax: 508-790-6230 Building'Commissioner Permit no. Date AFFIDAVIT 4 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: k-00,F S h 1,11-6A,Le— Estimated Cost Address of Work: Owner's Name: Date of 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 Arowner 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 Registration No. 01/GI zqX Z ORP, Date Owner's Name g1or ms:Affidav _ ?lie Commonwealth of Massachusetts Department of Industrial Accidents Olf er nlloM599211oos --- 600 Washington Street ' Boston,Mass 02111 Workers' Compensation Insurance Affidavit n cs tzEaa name• lCa.fl� I.ee� �l ' ply location• city iphone# ?JIO ' 32 l I am a homeowner performing all work myself. �Caan a sole proprietor and have no one working in any a acity %///O ❑ I am an employer providing workers' compensation for my employees workng on this job. comnnnv name• address: dty- phone#t insurance rn. piicV# ❑ I am a sole proprietor,general contractor, or homeowner(circle one)and have hired the contractors listed below who have the following workers' compensation polices: .... .. comnanv namv ■ddm.v dty phone#' "'p ..... sornnce cm rev# comnanv name- " ': .: 'iaF::.... address: dtV• phone d- :.:.. ,zn.,: . lieu#' .. ,.. ..;;..;�•:.::. :i'> �• ....; nsurance co. Failure to —coverage as required under section 25A of IAGL 152 can lead to the imposition of c immai penaltln of a Dne up to S1300.00 and/or one years'imptksomaent as wall as tdva penalties in the corm of a STOP WORK ORDER and a Due otS100.00 a day against rue. I understand that s copy of this statement may be fotwuded to the Otfiee of Investigations of the DIA for coverage verincuim 1 do hereby eerti wider the paint and pauddes of perjury that the information provided above is taw.mid correct ature Date %01160 g) sign Print name Phane 0 oincial use only do not write in this am to be completed by city or town omdal city or town: peemtWlleense q �Buildin Depariment ❑Llconsiag Board chedcu Immediate response is required Meleetmen's Office C3Health Department contact person: phone M. ❑Other (mruo 9/93 PIA! Information and Instructions • w 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 cotes-- 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 due foregoing engaged in a joint enterprise..and including the legal representatives of a deceased employer, or the rec-n-er. . -ustee of as 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 &,o....,ig%,em-nw—me to do maintenance , construction or repair work on such dwelling house or an the grounds o: 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 Iocal licensing agency shall withhold the issuance or renew of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who ha not produced acceptable evidence of compliance with the insurance coverage required. Additionally,neither the commomveaith nor any of its political subdivisions shall enter into any contract for the perfOnn=cc of public work until acceptable evidence of compliance with the incnrnnce requirements of this chapter have been presented to the COIIQar-rtnn authority. /icy ::, Applicants Please fill in the workers' compensation affidavit completely, by checking the box that applies to yoursrtuatina and supplving company nacres, 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 lnm,*-+n=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 primed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of has to cons=you regarding the applicant. Please be sure to fill in the pc: kXLcease number which will be used as a reference number. The affidavits may be rearmed In the Department by marl or FAX unless other arraagemenms have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have nay questions• please is not hesitate to give us a call. �., FMIA /. The Dep:rnent's address,telephone and fax number. The Commonwealth Of Massachusetts Department of Industrial Accidents Olilce of Invesduadons 600 Washington Street Boston,Ma. 02111 fax#: (617) 727-7749 phone #: (617) 727-4900 eat. 406, 409 or 375 The Town of Barnstable oFrne r o Department of Health Safety and Environmental Services Building Division MASS 367 Main Street,Hyannis MA 02601 � 059. ArED MA't A Office: 508-862-4038 Ralph Crossen Fax: 508-790-6230 Building Commissioner HOMEOWNER LICENSE EXEMPTION Please Print DATE: /0 //q % O JOB LOCATION: Q.(A &'�-ee_f Wp SSW number street village "HOMEOWNER": T * um" _H Le pce � ' 3, j name home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside, on which there is,or is intended to be,a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. // ^ Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1 -Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems, particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care to amend and adopt such a form/certification for use in your community. Q:FORMS:EXEMPT Engineering Dept. (3rd floor) Map 193 Parcel 01b 60fermit# �, y House# J�yZ Date I d Board of Health(3rd floor)-(8:15 -9:30/1:00-4:30) V6 V R T-Fee Cpns oor/School Admin. Bldg.) 4' �O� by Planning Board 19 TOWN OF BARNSTABLE Building Permit Application Project Street Address t-( Z VWA� Aj , �Pr Village Owner ),�l 2 un P61-f-Weir Address 1^�f-Z v44 f;1r LAJ qt;-,N Telephone S1253 36 Z C17CI 1 Permit Request -,1zX R;nk u QnuiL LA-) t t t kA o a t v-,'(yild LP lDoytQ S1 Ft' Ole �C- 2 �� = I J"JSTn UI /J r (mac � GG�d?i (GrC 1 l�Jb-v N (�Lt'�1 First Floor square feet Second Floor square feet Construction Type LtXOp A--PfiAl( C , o g cx? Estimated Project Cost $ /m, o0 o Zoning District )fi ST Flood Plain Water Protection Lot Size 40.64-Z st Grandfathered ❑Yes ❑No Dwelling Type: Single Family t5j�_ Two Family ❑ Multi-Family(#units) Age of Existing Structure 'r- 2C:)o Historic House �es ❑No On Old King's Highway &Yes ❑No Basement Type: ❑Full ❑Crawl ❑Walkout A'6ther PtIfL-4--Li% -,— Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: Existing 7_ New Half: Existing New No. of Bedrooms: Existing q New Total Room Count(not including baths): Existing New First Floor Room Count Heat Type and Fuel: Adgas ❑Oil ❑Electric ❑Other Central Air ❑Yes ULND_ Fireplaces: Existing Z- New Existing wood/coal stove ❑Yes /ANo Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) ❑Attached(size) ❑Barn(size) l None ❑Shed(size) ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes QJN6 If yes, site plan review# - Current Use cc iVyt iZ)-Ge cj 0%42 rl Proposed Use Builder Information Name 0&,j Telephone Number Address �a z �� ti kt4,(;� �� 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 CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE ADATE WO( BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S) }� FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED MAP/PARCEL NO. ADDRESS a VILLAGE OWNER E DATE OF INSPECTION: FOUNDATION_ FRAME Celgb 7 INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING- ROUGH FINAL GAS: _ �; ,�-ROUGH FINAL FINAL BUILDINfrs c s Saar ws R.,•. .. DATE CLOSED OUT g ASSOCIATION PLAN NO. TOWN OF BARNSTABLE BUILDING DEPARTMENT HOMEOWNER LICENSE EXEMPTION Please print. . " DATE JOB LOCATION Number Street address Section of town '►HOMEOWNER" Name Home phone Work phone . 1 I ' PRESENT MAILING ADDRESS (Z�Z4 2- (,Lc 1.4-1 A_) 7 t , Q r)-(L-k 113 CCr Ck-A City town State Zip code The current exemption for "homeowners" was extended to include owner-occupie, 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(s)• who owns a parcel of land on which he/she resides or intends to re- side, on which there is,l•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 Offic: on a form acceptable to the Building Official, that he/she shall be resnonsii for all such work performed under the building permit. (Section 109. 1. 1) The undersigned "homeowner" assumes . responsibility for compliance with the S, 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 with said procedures and requirements. 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. 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 Q, 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 '•Owner� actin as supervisor is ultimately responsible. To ensure that the Home Owner is fully aware of his/bier responsibilities, man communities require, as part of the permit application, that the Home Owner zertify that he/she understands the responsibilities of a supervisor. On the la--t page of this issue is a form currently used by several towns. You may --are to amend and adopt such a form/certification for use in your community. Application to !'PPP +•��tl P,��f 7 060 •'' Old King s Highway Regional Historic District Committee in the Town of Barnstable for a CERTIFICATE OF APPROPRIATENESS Application is hereby made, id triplicate-, for the issuance of a Certificate of Appropriateness under Section 6 of Chapter 470. Acts and Resolves of Massachusetts, 1973, for proposed work as described below and on plans, drawings or photographs accompanying this application for: CHECK CATEGORIES THAT APPLY: 1. Exterior Building Construction: Q New Building ❑ Addition K Alteration Indicate type of building: Z 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 M ADDRESS OF PROPOSED WORK 5Y2• PAIN ST. PV• 8AkIf.SVA6LF_ ASSESSORS MAP NO. 133 OWNER BILL 4;' WATE PLeTTIVEi-- ASSESSORS LOT NO. /0 HOME ADDRESS SA E 759�f- *5-5 TEL. NO. 3b2-3011 KAM woKK FULL NAMES AND ADDRESSES OF ABUTTING OWNERS. Include name of adjacent property owners across any public street or way. (Attach additional sheet if necessary). 0%Zm�s f� ►3a�-ba�� 3Zrr6tf. .goX -1S3 W. �3arrl5f�GCc. 02�(og �A 4 7L+- �Jzw rde,4,L L- n c h z8 �-W o lv Lart_, W. &,un'5raJ& 0 zt uB 4ev6 6-t �-h n c•�-le �r, /�I, J, �21Ce_ �a/ 20 �• sz -1 2 dnrer, 51 I`7z�1i� Seer w. mstz6� AGENT OR CONTRACTOR TEL. NO. ADDRESS DETAI.LED.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). • ��/ate. 3Z' S`/ce! door- 00,' 2-1 �9indo�,t 2. lnyrd 11 '4' L �ch door open II�p onto 2)C/st i' CA4 - I nq del r 3, 7�e�arilt exft rior t`nr� white; no color c�e 4. R"iot_ e)cler i0r' doors (j-arr) r&; �o C Dbr CAA/XAe� — S• : t�esh�i�(2 hov5� Cwf . Cedztr s�dewa//s� . Signed Owner- ontractor-Agent Space below line for Committee use. Regi ved b H.DU. D Date 7! The Certifica is hereby e i� MAR 2 T 19M `� . . - - _ '/ CTMJ� Time o s— P TO` I gy ..�..,,, e&WOAk Approved ❑ IMPORTANT: If Certificate is approved, approval is subject to the 10 day appeal period provided in the Act. Town of Barnstable Old King's Highway Historic District Committee SPEC SHEET FOUNDATION SIDING TYPE Gl1 % CP-dZl� Sh nAC:� COLOR CHIMNEY TYPE COLOR ROOF MATERIAL COLOR . _ i PITCH WINDOW CqgGMG'Yfi SIZE ?,4 TRIM COLOR WYU DOORS C((S1b►k'1 iVl�COLOR� rOd SHUTTERS COLOR I GUTTERS DECK GARAGE DOORS COLOR ' SIGNS — COLORS FENCE COLOR i i NOTES: Fill out completely, including measurements and materinls/colors to be used. Three copies of this i form are required for submittal of an application, along with three copies each of the plot plan, landscape plan and elevation plans, when applicable. Plot plan need not be "Certified" except for new homes, but should show all structures on the lot to scale. SPECSHT Lc. .��/3 q = Work -WZL Lod- a � '¢�CoD S . 41 �? - N 1, 37� Z`38 ' `I,Y/ti 2vvT. I certify that this propertyE' located in Flood Hazard Zone C (o is side the 00 (out- ified by the Department of Housing iand tUrban Development (HUD) . Date���, ZB /99� -Or CERTIFIED PLOT PLAN M EDwA D `y LOCATION ,. SCALE . .. .... DATE Reg � do-Sb PLAN REFERENCE B�7.cvG a AfCl51 fF fir` I certify to its title insurance company that there are no visible encroachments I CERTIFY THAT THE .� isT!�!G Dtv��1AIC or easements except as shown and that this SHOWN ON THIS PLAN IS LOCATED ON THE GROUND i plan was prepared under my immediate AS SHOWN HEREON AND THAT IT CONFORMS TO THE supervision, SETBACK REOUIREMENTS OF THE TOWN OF .WHEN CONSTRUCTED. DATE /�c•G Z2/yy� REGISTERED LAND SURV OR w tf�cJ J ' tR • _�• ..,yam. � 'A • •r.i 1i J•.��,• 1 J 1 CF'ME A The Town of Barnstable • 6AMSTABM • 9� Department of Health Safety and Environmental Services 59. 1% 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 Worker {,'(A i <SL Est. Cost Address of Work: )�(2 LA_A M ti C (� N-bl A, Owner's Name L1 /� �� 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 kffowner 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 Registration No. OR Date Owner's Name The Commonwealth oj.4fassachusctts A:i Dcparnne»t ojlurlustrial•4cciflents Office 81/nvesV92118ns 600 W%r1•httig-totr Street Boston.A1u.vs. 02111 Workers' Compensation Insurance Affidavit �PPlic tit information• — Plc;tse PRINT IebNy dame �J���\i e� Inc•ition•�� 2. ,L".Ai 1J CA_J 9 X-lLKfil?-6 23 L,C� V-•c city 12hone# 2-of 7L( ) a homeowner performing all work myself. d h w I am a sole proprietor an have no one working in any capacity ..�:.'.tvw!•�-.r.���P^:�w_..........t'!_^•r:-IM b...'t_S'IA�TY T,.�Nt„ -r,�� lw.•.a•^wT'w�.w•A•.�+ ... L:-._.-..._.._.:.,..,.......u.�✓—...a...�► - .Sitar .,.....,._..... . ::,... - - am an emplover providing workers' compensation for my employees working on this job. coumany name: idd ress: city: Phone#: insurance co. pnlicv# I am a sole proprietor, general contractor, or homeowner(circle one) and have hired the contractors listed below who have the following workers' compensation polices: company name: address: city: phone At, insurnncc co pnlicy# :Y•^..:....ram __�.__�._�_�._. -_ �;�Ca••^l.�nwS•. � ._�._.__ .p•_ ...i..-..-.. comnnny nnnte• address: tin Phone# incurnnee co policy# :Attach additional sheet if riecessa ." .r. - -^+ "•� ...r _ T' �� '' '�''"'""-� "=y^' - ' Failure to secure coveraim as required under Section 25A of NIGL 152 can lead to the imposition of criminal penalties of a line up to 51.500.00 andiur une%cars'imprisonment as well as civil penalties in the form of a STOP NVORK ORDER and a fine of 5100.00 a day against me. I understand that a cope of this statement may he forwarded to the Office of Investigations of the DIA for coverage verification. 1 do herehr certif tint to pains and penalties o er un that the information provided above is truT u TCf. SiEmature Date Print name Phone 9 '�oflicial use only_ do not writc in this area to be completed by city or town official city or tmyn; permit/Iicense st r�Btiilding Department OLiccnsing hoard check ff im eta r 'red 0Seicctmcn's Office t `.; Dllcalth Department contact perst phone#; nOther ire,ued i:'r;NA . . 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 anv two or more 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 dwellings pouf or on the grounds or building appurtenant thereto sliall not because of sucli employment be deemed to be an employer. j. MGL chaj)ter 152 section 25 also states that every state or local licensing agency shall -,vithhold the issuance of- renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant N%•ho has not produced acceptable evidence of compliance -with the insurance coverage required. Additional[\-. 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 ha been presented to the contracting authority. Applicants Please fill in the workers- compensation affidavit completely, by checking the box that applies to your situation and suppl\'in�= company names. address and plione 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. 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 leave 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. , 7777 City" r Towns Please be sure that the affidavit is complete and printed legibly. Tile Department leas provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations leas to contact you regarding the applicant. Plea: be sure to fill in the permit/license number which will be used as a reference number. The affidavits may be returned tc 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 am question please do not hesitate to give us a call. Tile Department's address. telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents Office of Investigations 600 NVashington Street Boston,Ma. 02111 fax #: (617) 727-7749 phone #: (617) 727-4900 ext. 406, 409 or 375 .l a FEE IIEA, 4 TOWN OF BARNSTABLE,' MASS. ,1� b 722 d.0 O MCA THIS IS TO CERTIFY THAT,A PERMIT IS' HEREBY GRANTED:TO -. vasi _................... ......... ....... ..... ...... ........ ........ (ADDRESS) .� (PROPERTY OWNER) ��\ o V N TO ....... ........ ......... ........ ...—......_ V 4q.0 (BUILD) (ALTER) _'. (REPAIR). .............. ... ........ ..... .. A d (TYPE OF BUILDING) IA P_PROXIMATE'9IZR) f /may^ ��1 0.• LOCATION ... _ ' IAA�;�A Q I (STREET P.;D NUMBER ER1� -t� k _ (VILLAGE) l E III, NAME OF.BUILDER.OR CONT.RACTORs" � � -- •... • M w v A I. d AP ROXIM P ATk, COST -- -ta .;hcs I HEREBY AGREE;TO C I ORM'TO'ALL THE RULES AND REGULATIONS OF THE TOWN OF BARNSTABLE, REGARDING�THE�ABOVECONSTRUCTION (OWNER) . t¢�p t u (CONTRACTOR) .....: ..........+ ..... ........- p' BUILDING INSPECTOR v\ Subject to Approval ofBoard of?Health lam- P n , � � � � 1 � �,, c r \ � \J r�y� Y� ail,::..... .... -..i^^'.+...m......r—r.. ;c'r.:�.' �, ". e� l. 4 -"h }•Yi'^."-; �_'9 '"t tY $Y1 W T.r, t� Assessor's map, and lot number , . ...,..: x y �. -• f Sewage''Permit number ..� �.. .................... r'i ......:. � e�P o TOWN OF BARNSTABLE �I Z BARNSTADLE, i 169 •,� WILDING INSPECTOR I D MA a• n ' I APPLICATION FOR PERMIT TO ................ ,i................... ................................ i TYPE-OFF CONSTRUCTION ..... ....... ................................. .�...f .19 TO THE INSPECTOR OF BUILDINGS: x• .,, The undersigned hereby applies for a permit according to the following information: Location'.{E......... .......................................... Proposed Use ........ ...................... r Zoning District ....'. '/..! Fire District � ,_. / . .r ....... Name of OwneG�. TTirt` "' f /"' `� ���� ........................... ............h .. ............ .........Address4 <./_."" ......�.. . ... ��. ...�:. .. .... Name of Builder ................ ...... ..........................................Address s tom, /r C; / 7� � iName of Architec-t-5;r ....................:.....................Address ......... ...�..�......... . ......................................... Number of Rooms .........,.:........................................................Foundation ...... ....... II ` ierior ....................................................................................Roofing /� � ...: "�ff/1 �' 1�... ....... " r< s � ' Floors Interior...:... . .. �...... a�- -F.ieating ......... ..........�" .. .........................:.Plumbing ....... .... Fireplace , f .................... Approximate. Cost Z2 z jal �> Id- ........ ..... Definitive Plan Approved by Planning Board _________________19________. Area .............. ...................... Diagram of Lot and Building with Dimensions �i' i � ��, :r �, � � Fee .....:........................................ SUBJECT TO APPROVAL OF BOARD OF HEALTH r r i� f ` •iX, �/ I hereby agree to conform to all the Rules and Regulations of the/Town of Barnstable regarding theAa.bove construction. ` f... . ........� ............. U . ............... Booth, George W. & Harriot E. No .17226 Permit for ....add to frame / ..... ..................... dwelling .....................................................1.a�1.C)...L.)........ Location West Barnstable Owner . George W. & Harriot .Booth ............................9................................... Type of Construction frme .....................a..................... ................................................................................ Plot ............................ Lot ................................ Permit Granted ..............July,.,ZZ..........19 74 Dpte of Inspection ....................................19 Date Completed ......................................19 L PERMIT REFUSED ................................................................ 19 ............................................................................... ................................................................................ ............................................................................... ............................................................................... Approved ................................................ 19 ...............................................................................