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1344 MAIN ST./RTE 6A(W.BARN.)
a e e J � llll � 2z UPC 12543 No. 53LOR HASTINGS, MN Town of Barnstable Regulatory Services E ZFIE Tp� o Richard V. Scali,Director Building Division MASS. Paul Roma,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Approved: Fee: Permit#: HOME OCCUPATION REGISTRATION Date: iU ~d/'&t Name: Phone Address: OA g �� VY PLn village: � 1� Name of Business: ' S� - Type of Business: `d6/m " Map/Lot: INTENT: It is the intent of this section to allow the residents of the Town of Barnstable to operate a home occupation within single family dwellings,subject to the provisions of Section 4-1.4 of the Zoning ordinance,provided that the activity shall not be discernible from outside the dwelling: there shall be no increase in noise or odor;no visual alteration to the premises which would suggest anything other than a residential use;no increase in traffic above normal residential volumes;and no increase in air or groundwater pollution. After registration with the Building Inspector,a customary home occupation shall be permitted as of right subject to the following conditions: • The activity is carried on by the permanent resident of a single family residential dwelling unit,located within that dwelling unit. • Such use occupies no more than 400 square feet of space. • There are no external alterations to the dwelling which are not customary in residential buildings,and there is no outside evidence of such use. • No traffic will be generated in excess of normal residential volumes. • The use does not involve the production of offensive noise,vibration,smoke,dust or other particular matter, odors,electrical disturbance,heat,.glare,humidity or other objectionable effects. • There is no storage or use of toxic or hazardous materials,or flammable or explosive materials,in excess of normal household quantities. • Any need for parking generated by such use shall be met on the same lot containing the Customary Home Occupation, and not within the required front yard. • There is no exterior storage or display of materials or equipment. • There are no commercial vehicles related to the Customary Home Occupation,other than one van or one pick-up truck not to exceed one ton capacity,and one trailer not to exceed 20 feet in length and not to exceed 4 tires,parked on the same lot containing the Customary Home Occupation. • No sign shall be displayed indicating the Customary Home Occupation. If the Customary Home Occupation is listed or advertised as a business,the street address shall not be included. • No person shall be employed in the Customary Home Occupation who is not a permanent resident of the dwelling unit. I,the undersigned,have read and agree with the above restrictions for my home occupation I am registering,. Applicant: Date: Homeoc.doc Rev.06/2 ,i YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates (cost$40.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you must do by M.G.L.- it does not give you permission to operate.) You must first obtain the necessary signatures on this form at 200 Main St., Hyannis. L Take the completed form to the Town Clerk's Office, 1st Fl., 367 Main St., Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is required by law. DATE: l2 5 ZOfco Fill in please: M EM0CO3 �► `' '` APPLICANT'S YOUR NAME/S: CTE5rr- C3 C:3 IM r" BUSINESS YOUR HOME ADDRESS: M41K 6A�,&a0.96 t ��000 TELEPHONE # Home Telephone Number ro9 .rdlO��9��i NAME OF CORPORATION: NAME OF NEW BUSINESS TYPE OF BUSINESS C,9510011i94AAt, &X46m.TINA IS THIS A HOME OCCUPATION? YES N ADDRESS OF BUSINESS MAAOM iOr- V AIX MAP/PARCEL NUMBER t77 /oo(v' (Assessing) When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. - (corner of Yarmouth Rd. &Main Street) to make sure you have the appropriate permits and licenses required.to legally operate your business in this town. 1. BUILDING COMMISSIONER'S OFFICE MUST COMPLY WITH HOME OCCUPATION This individual has been infor ed per uirements that pertai to this type of businesqjULES AND'REGULATIONS. FAILURE TO Authorized natur ** 691HI�Ly MAY RESULT IN FINES. 9 COMMENTS: 2. BOARD OF HEALTH This individual has been informed of the permit requirements that pertain to this type of business. Authorized Signature* COMMENTS: 3. CONSUMER AFFAIRS(LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature* COMMENTS: YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates (cost$40.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you must do by M.G.L. -it does not give you permission to operate.) You must first obtain the necessary signatures on this form at 200 Main St., Hyannis. Take the completed form to the Town Clerk's Office, 1 st FI., 367 Main St., Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is 'r required by law. DATE: Fill in please: � c�rr► APPLICANT'S YOUR NAME/S: BUSINESS YOUR HOME ADDRESS: �3�4 M/ IN 15 TELEPHONE # Home Telephone Number. Pof 905!1 NAME OF CORPORATION: NAME OF NEW BUSINESS '5-C TYPE OF BUSINESS C-60141 V-IQt. IS THIS A HOME OCCUPATION? YES N ADDRESS OF BUSINESS MAP/PARCEL NUMBER t77 /oo(v (Assessing) When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. - (corner of Yarmouth Rd. &Main Street) to make sure you have the appropriate permits and licenses required to.legally operate your business in this town. 1. BUILDING COMMISSIONER'S OFFICE MUST COMPLY WITH HOME OCCUPATION This individual has been =Z;yZFfr&iremernts that pertain t� o this type of busines%LES AND REGULATIONS. FAILURE TO Authorized gnatur ** C®MI�L`� MAY RESULT IN FINE$!. COMMENT 2. BOARD OF HEALTH This individual has been informed of the permit requirements that pertain to this type of business. Authorized Signature* COMMENTS: 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature* COMMENTS: Town of Barnstable *Permit# �V e Expires 6 months from issue date Regulatory Services Fee_ 3.S` sAxrvarASLe MA89. Richard V.Scali,Director 16;q. RFD MA'S ----BUff&M9—Di — Tom Perry,CBO,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PEPMT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint oP�� Map/parcel Number r !� _ ss Property Address 'Y 1-11 H S 7, �(� �P A Id• "D�MS t 6,8(,f— A Residential Value of Work$ �l 6-00, CIO Minimum fee of$35.00 for w h 000 00?Q, s Owner's Name&Address / D /' 3 g�1f P ��, IA 13Ley ,44,-�A� sT g,. gyp . Id, a ,vsThe Nt Contractor's Name -q Telephone Number SJ 9—S66 ^ 3- Home Improvement Contractor License#(if applicable) 1 1 7 (o Email: W we t3c3 S © �n'►✓� .CCJ�►'� Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: am a sole proprietor ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑ Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) �e-side ❑ Replacement Windows/doors/sliders.U-Value (maximum.32)#of windows #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical& Fire Permits required. 'Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. 'Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is required. SIGNATURE: G 1/V Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc Revised 040215 ;•i Tlie Comnrorriveakh of Massachusetts Depararrent o,f Industrial Accidents O,fire o,f imwlkadons 600 Washington Street — 1;F —.--------------- Boston,CIA OZII�' -------_-_------ - -- --- ----- --- fvrvturrraxsgov/dia Workers' Compensation Insurance Affidavit Builders/ContractorsJEIectricians!Plumbers Applicant InfGn affan Please Print Leeibly Name(Basmessl�OFganir�Eioallad�vidnal�: �f�v t D �/ L--1 vv/3 Address: P. O 1PSGX Cityftatel :1=• r=�� j j Ov'l3 Pllvne o Ire,- Are you an employer?Check the appropriate_ba • Type of project(required): 1.El am a employer with. 4. 1 1 afn a general coni=actor and I 6. ❑New construction employees(full and/or part-time),* have hired the sub,-contmetors 2.❑ I am a sole proprietor orpartner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees. These sub-contractors have g_ ❑Demolition wad-ing for me in any capacity. employees aad have workers' 9. ❑Building addition [No wmi mrs' comp.insurance Comp-msuranee_1 required-] 5. ❑ We area corporation and its 14.❑Electrical repairs or additions 3_❑ 1 am a homeoumer doing all work officers have exercised their I L❑Plumbing repairs oiadditionns myself[No y�or�•erg_ right of exemption per MGL 12.0 Roofrepairs insurance rewired.]Y c.152, §1(4h and we have no employees-(No workers' a❑Other comp.insurance required.] •Any WBcam2 Heat chedhss box F1 must also fill out the section below showing their waAeW compeasatina policy inf rmstim Homeowners who submit this affidat,ft iru51a -9 they are thing all wat and then}tire Gum&contractors must submit a new of idwit indicating sacIL ZCd=wtm thst check this box mast attached sir addiilional sheet showing the nuae of the sub-comrwim and state whether at not tbose ewides have employees.Iftheavb-contrectorshaveemployee%dseymnstpmvidetheir workers'comp.policy number. lam an eitipinyer tliat is prouidiry workers'compeusaf'an insurance f or my enrpIolves. Below is tine policy arrd job site informadom Insurance Company Dame: Policy 44 or Self--ins.Lic.*. Expiration Date: Job Site Add. /Ll `A( S7• �Ti�n City/StaW2f p: S7-4tt-f A44- Aftach a copy of the workers'compensationpolicy declaration page(showing the policy number and expiration date). Failure to secure coverage as required.under Section 25A of MGL c. 1572 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonmenk as well as civil peuabies.in the form of a STOP WORK ORDER and a fine of up to$250-00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for insurance coverage verifrsa#ion. I do hereby crT r unrder epauns and penabYes /perjury that the informat$on>prmri&Jabm e i s truce and correct Sisnature: Date: to r Phone]k u 6tl— Official use only. Do not}mite in this area,to be calnpieted by city or town o f j'icurt City or Town: Perm it/License; Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.Citylrowa Clerk 4.Electrical Inspector S.Plumbing Inspector 6.Other Contact Person: Phone 9: Information and Instructions ` Massachusetts General Laws chapter 152 requires all employers tO provide workers'compensation for their employees. pmsuantto this sfstrte,an.vnployee is defined as.'—every person in the service of another under any coact of hire, express or implied,oral or wrhten.." aria association,corporation or other legal entity,or any two or more An esrprcy�is defined as"an individual,p ersh�, of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an indivi&2A partnership,association or otherlegal entity,employing employees. However tiro owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the . dWPlimg house of another who employs persons to do maintEllaace,construction or repair wo�c on such dwelling house or on time grounds or building appndn�thereto shall not because of such employment be deemed to be,an employer." MGL cbapter 152, §25C(6)also stems that"every state or local licensing agency shall withhold the issuance or renewal of a Hcerxse 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.cover-age required." Additionally,MCM chapter 152, §25C(7)states-Neither the commgnwealth nor my of its political subdivisions shall enter into any contract for the performance,ofpnblic work until acceptable evidence of compliance with the insaranCB. regzurements of this chapter have been presented to the contnfractbag aufho6ty-" Applicants Please fill out the wows' compensation affidavit completely,by chug the boxes that apply to your sitnation and,if necessary,supply sub-contractor(s)name(s), address(es)and Phone number(s)along with their certificates)of insurance. Limited Liability Companies(LLC)or Limited Liability-Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have empIoyees,a policy is regnaed. Be advised that this affidavit maybe ndh to the Department of Industrial Accidents for eonfamation of insurance coverage. Also be sure to sign and date the affidavit The affidavit should be mtmmed to the city or town that the application for the permit or license is being requested,not the Department of Irvin st-r;al Accidents. Should you have any questions regarding the law or if you are requited 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 pried.legibly. The Deparment 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 pen idncense number which will be used as a reference number. In addition,an applicant that must submit multiple peniaWlicense applications in any given year,need only submit one affidavit mdicatmg current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations>n (may or town):'A copy of the affidavit that has been officially stamped or maticed by the city or town may be provided to the applicant as proof that a valid affidavit is on file for ftrttue permits or licenses A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture, (i-e. a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit The Office of Investigations would ae to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Dep_artmenfs address,telephone and fax number The CDn:MonweS tir of Mrs sachusetfs , Depadmmt cif Iadustdal Accidents Office of jvestkatio= 604 Wasbingtan Strut Baston=MA 02111 Tf,-1,4 617 727-4900 Cxt 406 or 1-97 MA SS-4 Fax#617-727-774-9 Revised 4-24--07 I 6Q,,vnaancuea�th a�Cl� aac�u°elt License or registration valid for individul use only Office of Consumer Affairs&Business Regulation i before the expiration date. If found return to' Business Regulation HOME IMPROVEMENT CONTRACTOR Office of Consumer Affairs and Type: ' 10 FarkFlaza-Suite 5170 Registration:_:;.!1.9766 Boston,MA 02116 Expiration.'�B`/28(2Q17_.• DBA WEBB CRAFT DESIGN:_ _'.:.>=;- ;?'•.,: \ / DAVID WEBS 25 MEADOW VIEW Not valid without signature EAST FALMOUTH,MA 02536 Undersecretary Massachusetts -Department of Public Safety Board of Building Regulations and Standards tr'N(_11U17 Supef'�isor License: CS-046189 DAVID H WEBB .. 32 F.R Lillie Road Woods Hole MA 82543 I use group v4bich C... Buildings of any 991m)of -� - Expiration Unrestricted" 35,000 CubiC feet commissioner 10/29/2016 contest less than enclosed space. the Massachusetts ev Failure to possess a current f itiO ration of this license. State Building Code 15 cause v,,w Mas,.Gov/DP' For DPS Licensing information visit: _ _- �0*1HE + BARNSTABLE. MASS, Town of Barnstable 'Dreo F;�a't a Regulatory Services Richard V. Scali,Director Building Division Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 er Prop ty Owner Must Complete and Sign This Section If Using A Builder 1 E/.0 �� � , as Owner of the subject property hereby authorize 1`t L4 6 to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of Job) S• tature of Ow er Date Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. Q:\P,.PFILL-S\FORMS\building permit forms\EXPUSS.doc Revised 061313 VWuOR,KERS, CO.MPENSAT,ON 30. 2015 11 : 51AM Dowling & 0'Ne i 1 No. 7431 P. 1/1 AND EMPLOYERS LIABILITY INSURANCE POLICY Information Page WC 00 00,01 Atlantic Charter Insurance Company VDAC NCCI Co. No.:29211 Policy Number: WCV01243700 1. INSURED: Prior Policy Number: New Robert Tyndall Producer. 80 Brigatine Avenue Miller McCartin, Inc. DBA Hyannis, MA 02655 Federal 1D Number:999100972 Dowling $ O'Neil Insurance Risk ID Number: Agency PO Box 1990 Business Type: Individual SIC:9999 NONCLASSIFIABLE ESTABLISHMENTS Other Named Insured;See WCE 106 Other Work Places: See WCE107 2. POLICY PERIOD' The Policy Period Is From: 7/15/2015 To 7/15/2016 12:01 A.M. Standard Time at The Insured Mailing Address 3.- COVERAGES:. _. _ . .. - ..... A. Workers Compensation Insurance: Pert Orie ofltie policjr eppliea To the WorkeP Cbinpensatlon haw of the-states lrste - - here., MA B. Employers Liability Insurance: Part Two of the policy applies to work in each slate listed In item 3A. The limits of our liability under Part Two are: Bodily Injury by Accident $ 500,000 each accident Bodily Injury by Disease $ 500,000 policy limit Bodily Injury by Disease $ 500,000 each employee C, Other States Insured: Part Three of the policy applies to the states, If any, listed here: COVERAGE REPL.ACEA BY ENDORSEMENT WC 20 03 0613 D. This policy Includes these endorsements and schedules: See VICE 105 4. COVERAGES: The Rati premium Plans,All Informal on required below issu ll subject to venlicalloneend change by au Classifica(ions, Rates 6 audit Premium Basis Total Rate Per Estimated Code Classifications No. Estimated Annual $100 of Annual Remuneration Remuneration Premium See WC 00 00 01 Minimum Premium: Deposit Premium: $550 $8.830 Interim Adjustment: Annually Total Estimated Premium $8,373 Servicing Office: Surcharge(s) 457 25 New Chardon Street Boston, MA 02114-4721 Total Premium and Surcharge(s) $8,830 Issue pate 07/21/2015 Countersigned By:_ � Form;100mv Copyright 1987 National Coundl on CompenssGon Insurance i rp Town of Barnstable *Permit# p Expires 6 months from issue die Regulatory Services Fee A& ';,? a -7 BAMS BL& 0 tKnss.1639. Richard V.Scali,Interim Director '°tEp Mp.`l Building Division Tom Perry,CBO,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY �� Not Valid without Red X-Press Imprint Map/parcel Number 1 I Property Address go;,g-✓S•GwVe—e rJ ❑ Residential Value of Work$_/ (00 Ca Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address ZZ-F— L3 L=Ck[;�J Z R Q , 3 0-,?, -9 79 WG=�v r 13/�/LNS QaLrO 104 p,96 FF Contractor's Name D , 4 Telephone Number Home Improvement Contractor License#(if applicable) 1 (97 G 6 Email: D © I Construction Supervisor's License#(if applicable) l/ 9 , � :,� -I%A ❑Workman's Compensation Insurance Check one: ® I am a sole proprietor APR - 7 2014 ❑ lam the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name TOWN OF BARNSTABLE Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. C(—Oovv — ar) 5 PH--0 Permit Request(check box) W L=l�-7�-c-==�/2�"'t> l�✓G�"t7 3o y�_� /�-�/-c� �n� l-�i�5 v�4. Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to vlhzmoyp 1,4"o t.L ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders.U-Value (maximum.35)#of windows #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is required. SIGNATURE: #-(414M___ Q:\WPFILES\FORMS\building permit fonns\EXPRESS.doc Revised 061313 ' The.Commonwealth of Massachusetts Department of IndustrialAccidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.govIiha Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): Address: , I"-G- /&x 4I l o0-SY,�; City/State/Zip: Phone#: S p S — 6 G —3 3 2 Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. W I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. El New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-cont-actors;have g• ❑Demolition workingfor me in an capacity. employees and have workers' Y P com insurance•$ 9. El Building addition [No workers comp. insurance required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions officers have exercised their 3.❑ I am a homeowner doing all work ' 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 hue outside contractors must submit a new affidavit indicating such, tContractors that check this box must attached an additional sheet shouting the name of the sub-contractors and state whether or not those entities bave employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: A 1—L, G CL¢1�927�72 - Policy It or S elf-ins.Lic.#: W/ C V®d 3 d 1-0 9 Expiration Date: 47 // 1 Y Job Site Address: 90ft 16 6-e City/State/Zip: (4•- 0966 97 Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby c RJYunder the ains and pe o perjury that the information provided above is true and correct Signature: Date: ! _ 7 Phone#: -a 8 .��� —3 3 C9 Of use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions _ Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in*a joint enterprise,and including the legal representatives of a deceased employer, or the receiver or trustee of an individual,partnership,association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter-152, §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( )states"Neither the commonwealth nor any of its political subdivisions shall enter into any contracf 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 numbers)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call.the Department at the number listed below. Self-insured companies should enter their self insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has-to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (Le.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would hke 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 kvestigations 600 Washington Street. ` Boston,MA 02111 Tel#617-727-4900 axt 406 or 1-877-MASSAFE Revised 4-24-07 Fax#617-727-7749. www-ma.ss.gav1dia r I t 1 - i oF +era,, Town of Barnstable Regulatory Services a NAM.STABLE Thomas F. Geiler,Director CFO 039. 9 A 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 USinQ' A Builder I,_ J �/~F t�C�� , as Owner of the subject property hereby authorize ® , 14, W F,13 6 to act on my behalf, in all matters relative to work authorized by this building permit application for. /n r del S (Address of Job) S reer Date Print Name .If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. Q TORM&O WNERPERMISSION oFtKWE r� Town of Barnstable P`�o Regulatory Services I HAMSTABLE Thomas F.Geiler,Director 16 9. ,0� Building Division a rfC � Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": 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 Persons)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be, a one or two-family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner." Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building 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 s Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control.. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:forms:homeexempt" 1 i .:...:...: ...:. zi BFRA�#CEt#C ' rlr ale Atlantic Charter Insurance Company VDAC NCCI Co. No.:29211 Policy Number. WCV00730207 9. IN Prior Policy Number. WCV00730206 Tyndall Roofing., LLC i Producer. 80 Brigantine Avenue Fredericks Insurance Agency, Osterville, MA 02655 Federal ID Number.204616445 Inc. Risk ID Number. PO Box 427 Osterville, MA 02655 Business Type: Limited Liability SIC:9999 NONCLASSIFIABLE ESTABLISHMENTS Other Named Insured: Other Work Places: 2. POLICY PERIOD: The Policy Period Is From: 7/11/2013 To 7/11/2014 12:01 A.M. Standard Time at The Insured Mailing Address 3. COVERAGES: A. Workers Compensation Insurance: Part One of the policy applies to the Workers Compensation Law of the states listed her: MA B. Employers Liability. Insurance: Part Two of the policy applies to work in each state listed in item 3A. The limits of our liability under Part Two are". Bodily Injury by Accident $ 100,000 each accident Bodily Injury by Disease $ 500,000 policy limit Bodily Injury by Disease $ 100,000 each employee C. Other States Insured: Part Three of the policy applies to the states, if any, listed here: COVERAGE REPLACED BY ENDORSEMENT WC 20 03 06B Tn:s policv includes tnese endorsements and schedules: Sae WCE 105 4, COVERAGES: The premium for this policy will be determined by our Manual of Rules, Classfications, Rates & Rating Plans. All information required below is subject to verm"cadon and change by audit. Code Premium Basis Total Rate Per Estimated Classifications No Estimated Annual $100 of Annual Remuneration Remuneration Premium See WC 00 00 01 Minimum Premium: Deposit Premium: $500 $500 I Interim Adjustment: Annually j Estimated Premium (Minimum Premium) . $500 Servicing Office., 25 New Chardon Street Boston; MA 02114-4721 Issue Date 06.,24/2013 Countersigned By: Date :a?vngnt 1987 National Counul on Compensation insurance 5rrr: 10Gmv �j _.._... exe q�oo7WA10,)zcoealC�o1�-,aC1ccoeCYd .-_.. . ..._ ._...._........................... Office of Consumer Affairs&Business Regulation License or registration valid for individul use only OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: egistration: yP 19.766 T e: Office of Consumer Affairs and Business Regulation �,. Expiration:`__8/28L2015i DBA 10.Park Plaza-Suite 5170 Boston A 02116 WEBB CRAFT DESIGN DAVID WEBB 25 MEADOW VIEW DR:;..�'�°_`�_.-;.; EAST FALMOUTH,MA 02536 i Undersecretary Not valid without signature Massachusetts - Department of Public Safety . Board of Building Regulations and Standards Construction Supen-isur License: CS-046189 DAVIDH WEBB 24 MEADOW VIEW D E FALMOUTH NIA 02536 i y_ , " '"" Expiration , Commissioner 10/29/201.4 r �o �sr-�✓ 6aJ / ` G� i `�L/! L �L vN-`�- TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Parcel"." LA�/ Appli Map- catio # Health Division -Date ISSL Conservation Divi8i6na),L c,J, )11 Fee plitation Fe Planning Dept. .�`.Permit Fee Date Definitive:Plan Approved by Plahning Board Historic - OKH Preservation Hyanni's Project Street Address Village �*vr W,2A Z Owner Address - U VV , Telephone s0 00 Permit 6quest —aj-a�I 1 2. Y, ( 6 Square feet: 1 st floor: existing—proposed ';2hd floor: existing—proposed Total new Zoning District. Flood Plain Groundwater,Overlay Project Valuation\4-000, Construction Type Lot Size Grandfathered: Q Yes L1 No If yes, attach supporting documentation. Dwelling Type: Single Family :•Q Two Family 0 Multi-Family (# units) Age of Existing Structure Historic House: L3 Yes Q No On Old King's Highway: LJ Yes Q No Basement,Type: Ll Full Ll Crawl Ll Walkout L1 Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing new Total Room Count (not including baths): existing new First Floor-Floom CoUbi- Heat Type and Fuel: LJ Gas Q Oil U Electric L1 Other Central Air: L1 Yes L] No Fireplaces: Existing New Existing wood/coal siobe: 43Yes Q No Detached garage: Ll existing Onew size Pool: Qexisting 0 new size Barn:,L) existing',h❑ n-ew size— Attached garage: Q existing U new size —Shed: U existing Ll new size Other: T— Zoning Board of Appeals Authorization Ll Appeal # Recorded L1 Commercial A Yes No If yes, site plan review # Current Use N:�d� Proposed Use—���� APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name &611AP,(20� Telephone Number WY- 9600 AddFres &e7t License # Cs— 09 IT00 Home Improvement Contractor# IY19S-3 Worker's Compensation # W C 1 00 S- —'9 1 YN If ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO_r A SIGNATURE DATE U h t FOR OFFICIAL USE ONLY g APPLICATION# DATE ISSUED MAP/PARCEL N0. r ADDRESS VILLAGE ' OWNER 4 < -DATE OF INSPECTION: _ I FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL 'FINAL BUILDING i DATE CLOSED OUT ASSOCIATION PLAN NO!f_,,"_ll 'R �,rEr .L O Of aTIIstable . Regulatory Services r *•�•.°,.1 = Thomas F. Geiler,Director $uEding Di YZS1 D n Thomas Perry,-CB O,•Bm7ding Cow,,,f.esi oner 26D Main Hya n , I fA 02601• w.tcwn bzrnstable_ws._vs •Offices 508-8624038 Fax: 508-790-6230' PLAN RE 177 0 Owner- - MaplP.mr., Project Addres ,• . The faElowm itet0-Tere noted.0n reviewing: n ttV 7-s o rn Re! ie•med by: i Dam L @ 3 b 4T lb xzsTIA) y -- - 1 ID \ I The Commonwealth of Massachusetts Department of Industrial Accitlents 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 yLe ibl Name (Business/Organization/Individual): `{'I wy f ►h Address:_�� f O Ll "V c any City/State/Zip: Z'V MA QVSS� Phone #: qZ1 - '?1PDb Are you an employer? Check the ppropriate box: 4. ❑ I am a general contractor and I Type of project(required): 1.0 1 am a employer with 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 cornp. insurance.: 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 I I.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12 ❑ Roof repairs insurance required.] t c. 152, §1(4), and we have no employees. [No workers' 13.❑ Other comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. +Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an emplwer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. y� n Insurance Company Name: c�,QCf� / Policy #or Self-ins. Lic. #: wo, �� �Ul �"I Expiration Date: Job Site Address: 134 4 KT pr Ilg� City/State/Zip: "V Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine Of ttp to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereb y c• tifv under the par a d pena tie�er jury that the information provided above is true and correct. Si nature: Date: Phone#: "J y O� `1 � (o Official use only. Do not write in this area, to be completed by city or town official City or Town: Permit/License# Issuing Authority (circle one): 1.Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone#: ® CERTIFICATE OF LIABILITY INSURANCE DAT6/29/2012 Y) AC®RD o /2s/ olz THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsements. PRODUCER CONTACT NAME: Germani Insurance Agency PHONE FAX 908 Main Street Ic No Ezt 508 428-9194 A/c No: 508 428-3068 Osterville,MA 02655 A DARESS• INSURE S AFFORDING COVERAGE NAIC q INSURER A:SAFETY INS CO INSURED INSURER B Scott Peacock Building&Remodelling,Inc. P.O.BOX 171 INSURERC: Osterville,MA 02655 INSURER D: Commerce&Industry Ins.Co. INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR POLICY NUMBER MMIDDIYYYY W MMIDD/YY A GENERAL LIABILITY CP00001152 7/5/2011 7/5/2013 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ CLAIMS-MADE OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ POLICY PRO- LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident UMBRELLA LIAB HOCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ D WORKERS COMPENSATION WC 005-81-5464 6/22/2012 6/22/2013 VVC SLIMIT ER AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 100,000 OFFICER/MEMBER EXCLUDED? ❑ N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Scott Peacock Building&Remodeling,Inc. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Fax#508-428-7625 Scott_Peacock@verizon.net AUTHORIZED REPRESENTATIVE - ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD I Town of Barnstable. Regulatory Services B B '� Thomas F.Geiler,Director �pIFD MAC A1� 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 A Ruildtr as Owner of the sub'ect ro e P P riY r • hereby authorize to act on my behalf, in all matters relative to.work authorized by this building permit application for: . <�X D (/J" jf, (Address of Job) ature of er Date Print Name Q:FORMS:OWNERPERMIS S ION t U/I,G �(.�Ci77/,9//.C�/[C(G'C/II�O/�(���LJdCGC'�l6dGIlJ Office of Consumcr Affairs&Business Regulation License or registration valid for individul use only OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: egistration: ,1`51853 Type: Office of Consumer Affairs and Business Regulation xpiration:, _7/.7/2014_ . Private Corporation 10 Park Plaza-Suite 5170 " Boston,MA 02116 SCOTT PEACOCK BUILDING,-&`REMODELING INC JAMES PEACOCK `>.' " :. ;!a'• .': `:.' 1046 MAIN STREET SUITE'=7`c' = OSTERVILLE, MA 02655 Undersecretary Not valid without signature Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supervisor ti • License: CS-094500 JAMES S PEACOOK PO BOX 171 OSTEVILLE MA'026'�ti, . Expiration Commissioner 07/22/2014 Unrestricted-Buildings of any use group which contain less than 35,000 cubic feet(991m3)of enclosed space. Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. For DPS Licensing information visit: www.Mass.Gov/DPS Assessor's map ,and lot number ......... ............... *'THE 0, Sewage Permit' number ................... .. . .................... SAW ST&BLE, House number ............................................................ ........ MAA& 039- M TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO &. ..e. ..... ................................................... TYPEOF CONSTRUCTION ....... ............................................................................ ......... ..............19........ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ..... ....... ...... .............. ...... ....................................................... ProposedUse ....... ..................................................................................................................................... Zoning District ........................................................................Fire District Aj ........A4�.e 5�r4 ........ .... ............................................. a) Name of Owner .... ........Address ... ....................................................... Name of Builder ..........Address ...................................................................... ..................-Name of Architect ......... ..........................................................Address .................................................................................... Numberof Rooms ..................................................................Foundation .... ............................................... Exterior ... e . ........ .................... . .................. ............................. .........................................Roofing ..................... . .................... ...Floors �� �/U.P ............................................. ...........Interior ..................................................................................... Heating ...... ............................Plumbing ............ . .... . .... .... . ........7 ..................................... Fireplac e. ..................................................................................Approximate Cost ..............:�5 ........................................................ Definitive Plan Approved by Planning Board --------------------------------19------- Area .........32 ............... ............... Diagram of Lot and Building with Dimensions Fee ....... ............. SUBJECT TO APPROVAL OF BOARD OF HEALTH 6'15 60, OCCUPANCY PERMITS REQUIRED FOR NEW-D-W&L-L-ING-S I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction.- Name 4M. .......... ... ............. Construction Supervisor's License McKEON, RAYMOND A=177-006 No ..... Permit for....A.4144-�... ... Acces�Ky ..................... ... Dwelling......... ... ....................... Location ....1 f.!�,Ain Street . ............................................. ...................West...B.ar.n.s.t.ab.i.e............................ Owner .........Rayu -McKeon .......................................... Type of. Construction ... ........................... ................................................................................ Plot ............................ Lot ................................ Permit Granted ..... .........19 85 Date of Inspection. ....................................19 Date Completed ....... ....................... .......19 0 "ooy 0 '000vc 1111197 ao O k'5- SEPTIC SYSTEM MUST ICI: °4 Assessor's map-and lot number .. .. .......... . �,ED IN COMPLIANCE �FTNETO� . v INSTALLED, TITLE 5 E. o Sewage Permit. number' ..................... 01 ................... ' WITH C®®E e ENVIRONMENTAL Z Bafib9T/1DLE, House number ................................................ ........................ TOWN' REGULATIONS rasa r �O s639. \0� �0 YPY a' TOWN OF BARNSTABLE BUILDING INSPECTOR I • APPLICATION .FOR PERMIT TO ..................................................... !✓ TYPE OF CONSTRUCTION. ....... 5KII-e................................I........................................... . � ....... ...........i9.�f TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location .? 411 � S 1.. .. . .. s.........�....................:�..............�...... ..... ........................�............ ................................... ProposedUse .......5.7-a... �� �.................................................................................................................................... Zoning District ...........................Fire District ..L�l! �'!.°l./"✓.(..'1.✓`"' Name of Owner ... 1%!'!?. !�.... G/ Jl/v........Address ... 7 �/ `� 5-7- ....' ).......!.....6�..... Name of Builder ..........Address .................................................................................... Nameof Architect ......... .......................................................Address ............:....................................................................... Number of Rooms ...............................................'..................Foundation .... ..... Exterior ... ..... ....... ..........................-12.................................Roofing .............0 Floors ........................................Interior ......................... -� Hu'. .................... 1...,................................................... Heating ......... ..................................................Plumbing ..........�ov ............... ... ... ..... ........................................... Fireplace d......... ............................................Approximate. Cost ..... (. .aq!..................................... ............. lo Definitive Plan Approved by Planning Board ____�__________________________19________. Area /'�.v. ............... Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH a 50` OCCUPANCY PERMITS REQUIRED FOR NEW D �? 6 4 I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name .............. �- Construction Supervisor's License ..v.�,.1... .... McKEON, RAYMOND No ...ZUK... Permit for ...BUILD GARA.GE...... ........ .... 4. #� Accessory to Dwelling ............... ................................................................ Location 1345 Main Street ................................................................ West Barnstable ............................................................................... Owner Raymond McKeon .................................................................. Typeof Construction ................Frame.......................... ................................................................................. "Plot ............................ Lot ................................ Permit Granted ...September...6.............19 85 "Date of Inspection .................................... .19 Date! Compl2--&ed h �it,Jen'._ ���.�j ''�� pit a`JL=.�,• � f j'~� I I { i ! \ �T :ice i 1 r / 1 { rL , fy Z-1--J�A - - , to gl i v { J i r.