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0298 PARKER ROAD
UPC 12543 No aPo�LONSJF�� HASTINGS,MN Town of Barnstable *Pe mit' 3 96 3 r off' 0 Expires 6 ptonthsftom issue date ,x+ Regulatory Services Fee D s s • g+i�xCrAR7�F + 1639. Richard V.Scali,Interim Director Building Division ����� ?t Tom Perry,CBO,Building Commissioner 200 Main Street,Hyannis,MA 02601 DEC 3 j www.town.bamstable.ma.us 20�3 Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERNUT APPLICATION - RESID 1 y , I,N) LE Not Valid without Red X-Press Imprint Map/parcel Number- -/-2--6 / �� ss- Property Addre � ��,�I�V UG Y Residential-.Value-of-Work-$ Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address 0-0 xlff n 3e,/1 4 re, "; ,r elm I/h4 4, Contractor's Name Telephone Number Home Improvement Contractor License#(if applicable) Email: Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: ❑ I 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 ©Retroof(hurrica a nailed)(not stripping. Going over existing layers of roof) e-side(�;-C V6 Replacement Windows/doors/sliders.U-Value , (maximum.35)#of windows #of doors: -P ❑ 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: Q:\WPFI1M\F0RMS\bui1ding permit forms\MRESS.doe Revised 061313 . r .The Commann AM of Massackmsdfr Deparhnent of IndustYi,a1 Acciden& Office of Investigations 600 Washington Street y Boston,MA 02111 wmv mass gnv/dia Workers' Compensation Insurance Affidavit Builders/ContmcbarslFlectrieians/Ph tubers Applicant Information /� Please Print Ley-bly GNiine(Hudhe C1'()ra nTTarionllndivld Iy -(: t_^)1��-Q G A VA1:4&e s:—aq 1 PU City/State/zsp: Svc- 3toa- Are you an employer?Check the appropriate, r 1.❑ I am a employer with - -I ai a general contractor and i Typeof project(required}: employees(full and/or part-time).* have hired the sub-contractors 6_ New camsfiictioa 2.❑ I am a sole proprietor or partner- listed on the attached sheet. y- ❑Reutodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. employees and have workers' [No workers' comp_insurance comp_insurance-19_ ❑Building addition required-] 5. ❑ We are a corporation and its 10_❑Electrical repairs or additions f £ officers have exercised their 3_Q I am a homeowner doing all work 1!_❑Plumbing repairs or additions _ 1£ o workers' right of exemption per MGL --myself � �F- 12.-.❑-Rnofrepairs .insurance required.]T c. 152,§1(4�and we have no t� employees_[No workers' 13-9 Other' comp-insurance required_] 'tYuy app&�that checks boa#1 nmst also fill out the section below showing their wookes'compensation policy infIIm7tinn. 1 ffameowners who submit this affidavit m&cating they axe doing on woo}and then hire outside contractors m=submit a new affidarh indiesbng such_ ?Contractors that check this boa must attached an additional sheet showhg the name of the sub-ca stractm and state whether or not those entities bavte envhwees. lfthe subtout®ctors have employees,they=wpmvide their workers'comp.policy number. .Tam an employer thatisprmidiag workers'congmisadon insurance for illy euWZayees. Below is the policy and job.site irtformadom lnmwmce Company Name: Policy 9 or Self-ins-Uc.# Expiration Bate: Job Site Address: City/State/zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number.and expiration date). Failure to secure coverage as required under Section 25A of MGL a 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 chril penalties in the farm 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 hemby cerh;fjr under the prints and penalties ofperjirty.that Hie info rmatian pro v&Ikd above is bus and correct �! , Signature: �� Bate: Phone# Official use only. Do not write in this area,to be completed by city or town official City or Town: PermitMicense# Issuing Authority(circle one): 1.Board of wealth 3.I drag Departmen 3.City1rawn Clerk 4.Electrical Lupector 3.Plumbing Inspector 6.Other Contact Person: Phone#: z THE Town of Barnstable Regulatory Services BAPNSTMi.Eg+ Richard V.Scali,Interim Director 1619. Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862403 8 Fax: 508-790-6230 Property Owner Must Complete. and Sign This Section If Using A Builder as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work au o ' ed by this building permit (Address o Job) Pool fence and alarms are the resp nsibility of the applicant. Pools are not to be ed or utilized before fenc is installed and all final inspections a e performed and accepted. Signature of Owner Signature of Applicant Print Name Print Name Date Town of Barnstable Regulatory Services ' otrzHE Richard V.Scali,Interim Director Building.Division anxNsrxsca. # Tom Perry,Building Commissioner nL+ss. • 200 Main Street; Hyannis,MA 02601 www.town.barnstable.ma.us Office: -508-862=4038' Fax: 508-790-6250 . HOMEOWNER LICENSE EXEMPTION a Please Print I.JJ—OB.Lo Tm ci<6 :�Gj V ( 1 )64A 11-Ai table M-0-oakv //n'��uu�mber (� �scut �/,, ` village "HOKlfOWNER":^C,0Ak�eA aJ�'iI120 o - 3Y)-Q�J home phone## , work phone# URREN_ MAILING ADDRESS C7'-1 GI I�/'�IG V ) C/G(4 41 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 hermit. (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. SignatureofHomeowner \�Apppi•oval of Building Official Note: .Threerfamily 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 F3MMYnON 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 1091.1-Licensing of construction Supervisors); provided that if the homeowner engages a persons)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. QAWPFII.ESIFORMS\building permit formslEXPRESS.doc The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations ' 600 Washington Street Boston,MA 02111 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information / Please Print Legibly Name(Business/Organization/Individual): / G d 4;f5 Address:2. 0 . ;3--*,U l it 1.110 � 19 City/State/Zip: ✓ 9Phone Are you an employer?Check the appropriate ox: Type of project(required): 1.❑ I am employer with 4. ❑ I am a general contractor and I 6. ❑Ne onstruction ployees(full and/or part-time).* have hired the sub-contractors 2. I am a sole proprietor or partner- listed on the attached sheet. 7. Remodeling ship and have no employees These sub-contractors have g, ❑Demolition working for me in any capacity. employees and have workers' 9. ❑Building addition [No workers' comp. insurance comp. insurance.x required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions ] officers have exercised their 11. Plumbing repairs or additions 3.❑ I am a homeowner doing all work ❑ g P myself [No workers' comp. right of exemption per MGL 12.❑Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13.❑ Other comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp,policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is thepolicy and job site information. Insurance Company Name: Policy#or Self-ins.Lipc.#: / Expiration Date: Job Site Address: /� ✓��P/� /�// �/�" City/State/Zip:^ / 4or ��craf 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. 1 I do hereby certify der t pains realties f perju that the information provided above is true and correct Signature: Date: Phone#: DZ Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An'employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the 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(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions_regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the 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 (i.e. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would lice to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel.#617-727-4900 ext 406 or 1-877-MASSAFE Revised 4-24-07 Fax#617-727-7749 wwvv.mass.gov/dia { Town of Barnstable =Permit# "*3y Erpires 6 nro rs rom ue r are X ER MIT Regulatory Services �'" 8'2008 Thomas F.Geiler,Director 3 Building Division TOWN OF gARNSTABLE 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 Numbet�1(d/ /0 Property Address _02 -5�s epao, e-y- X4(> ;r ❑ Residential Value of Work Minimum fee of$25.00 for work under$6000.00 Owner's Name& Addressej�h Contractor's Named �2S� tiG/7 ; Telephone Number -Va - �� 7 76 Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) dd , Orkman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance mp �- Insurance Company Name (.� / 41 Workman's Comp. Policy# r .17 Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) �e=roof(stripping old shingles) All construction debris will be taken to ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows. U-Value (maximum .44) •Where required: Issuance of this perm' s not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Prope wner must sign Property Owner Letter of Permission. o Improvement Contractors License is required. SIGNATUms Q:For :c mtr Revise071 ►� Town ofBat-nstable Regulatory Services Thomas F.Ceiler,Director Building Division Tom Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstablema.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder as Owner of the subject property hereby authorize. ��L. �-� C' to act on my behalf in all matters relative to work authorized by this building permit application for. pe�, W ' (Address of Job) k Signature of Owner Date Print Name Q:Fomis:expn&g ReviSC071405 y ` The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): 7,Z. rO S liC T7 Address: City/State/Zip: A yOM ;7fS �I,�9-o�Eal Phone k -7 7 3 Are you an employer?Check propriate box: Type of project(required): la a employer with 4. ❑ I am a general contractor and I 6. ❑New construction (/ employees(full and/or part- ' e).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet # ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers'comp.insurance. 9. ❑Building addition [No workers'comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑Electrical repairs or additions. 3.❑ 1 am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself. [No workers'comp. c. 152,§1(4),and we have no 1�Roof repairs insurance required.] t employees. [No workers' 13.❑Other comp.insurance required.] sAny 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 their workers'comp.policy information. I am an employer that isproviding workers'compensation insurance for my employees Below is thepolicy andjob site information. L �� Insurance Company Name: Policy#or Self-ins.Lic.#: �o��lo Expiration Dater d / Job Site Address: o ?& FaI4,, aqC� C' r / CitylState/Zip: 0 2 (o �_ 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$1,500.06 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 ag the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations-of IA r insurance coverage verification. I do here certify nd the pains and penalties of perjury that the information provided above is true and correct Signature: Date: 7 Z Phone#: �� 7 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#: I GOLDMAN & HOC. PACE02/02 04/I14/2008 15:15 506-790-0249 DAT6I'"wYIlvY) A ORD CERTIFICATE OF LIABILITY INSURANCE t,ia�goB 04 4 08 PRODUCER p Y AND COIiFEAS Cmnmmw-is NO RtG?ITS SP M'"W CERMtCA`M GOLDMAN 6 A830CIATE3 INSURANCE HOLDER.THIS CERTIFICATE DOE: NOT AMEND,EXTEND OR FINANCIAL SERVICES INC. ALTER THE COVERAGE AFFORDE I)MY THE POUCIES BELOW. 933 FATMOUTS RD. HTANNIS MA 02601 NAIC D Phone:508-775-6010 Faa:508-790-0249 INSURERS AFFORDMGCOVERAGE _ INSURED INSURER& ESSEX INSURANCP CO BRSRItRERE PILGR 4 INSUBM:M CO. T. L. HITCHCOCK CONSRRUCTION MyB RC; GRANITE .wmTz IySUPARM CO SERVICCE�S pINC 105 PBRNl00O2601 — NYANNIS MA INSURERe _ COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE(NSURED NAMEO ABOVE FOR THE POLICY PERIOD INDICATED.NOT"MIS'TANO N ANY REQUIREMENT.TERN!OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO VMICH THIS CERTIFICATE MAY BEG:'VE D OR MAY PERTAIK THE INSURANCE AFFORDED By 7HE POLIM DESCRIBED HERON I8 BUBJWrTO ALL THE TEM,EXO MIENS AND CONM NS OP SUCH POLICIES.AGGREGATE LIARS SHOWN MAY NAVE UMM P.EDlJR w BY PAID CLABAS — LTR NSR TYPBOPINSUtiANCB POLICY NUMBER DATE DATE IdEAIDOIYY — tam EACH CCIRRENCE E 1000000 GENERAL LIABILITY A X X CD t1A8 " *3CM332 07/28/07 07/28/08 PRBG Es jmEqTLa S 50000 CIAIMFkADIc ®OCCUR WDE P(.Uy ore p6reen► $5000 PERSC•JAL AADU INJURY S 1000000 GsMALAGGlResATE 32000000 GENL AGGREGATE LIMIT APPLIESPER: "Alp s-CDumpAOa 92000000 POLICY PRO•JECT LOC AUTOMIDBREUABOM CORGI•EDBAIGL£UMT i P=000621a230 12/20/07 12/20/00 S ANY AUTO ALL OMIED AUTOS BODIL7 INJURY i 250000 (Parpe Ian• SCHEDULED AUTOS X WREDAUT08 BMW INJURY 9-500000 (Par ao dmo) X NON-ONWEDAUTOS — ��n AMASE s 250000 AUTOI•NL--EA ACCIDENT 9 GARAGE LIABB.ITY ANY AUTO STUFF ry�� EAACC i plR}C •NL": AFRO i PaRCEBGArA8R%LLAIUMESL.ITY EACIR�COJARRRCE 9 OCCUR CLAIMS MADE AGal1±IE E E — i DEDUCTIBLE — i RETENTION 4 WORiRERSCOMPF2d jIWANb TC SJJt1Rs ER C EtaPLaY�TRryLIHIBtLm' 2246868 03/28/08 03/28/09 EL.EA*IICCIDEHRT 3500000 AWIPRFDAE�RM9 RCLUDE� EL Oil SA -It S 500000 OFyFe�tleeMEMBER ELDG AE-POLICY LIMIT 9500000 19,PECIAL PROVISIONS adaw OTHER DESDRIPTRON OF OPERATIONS I LQOAMW I VEH6CLJ:8I ERCLJStM OY ENDORSEMENT!SP6dAL PROUI9MM THE CERTI>cICAT& HOLDER ES LISTED AS ADDITIOMI, INSURED ATDA ACCORDIM 'O THE POLICY PROVISIONS CERTIFICATE HOLDER CANCELLATION CARRENT SHOULD ANY OF THE AWVE OESCRIM POT-LBES BE CANCELLED BEAOR0 THE BAPIRATION DATE TRIER£Of.SIRE I1:SUING DtSIfAERVt81b M 3AVRTR TO MAIL 30 DAYB WART6N NOTICE TO THE CERTIPRCATE HOLDER NAMI3 TO THE LEFT.BUT FAILURE TD 00 80 SMALL MPOSE NO CSLK LTRON OR LLADIIJTY OF AR'•IHli*UPON TN£WSURER,ITS AGENTS OR attTHOR EJVTA7tVE Ata2 U _ ACORD 25(2MI88) O ACORD CORPORATION 19" I ✓!e a��L License or registration valid for individul use only Board of Building Regulations and Standards before the expiration date. If found return to: - Board of Building Regulations and Standards HOME 1MPROVERdENT CONTRACTOR One Ashburton Place Rm 1301 A Registratton:. 158W Boston,Ma.02108 E3tjs!Wow -22WWI0 Tr# 264153 Ty0w. Private Corporation T.L HrrCHCOCK SERVICESzINC. TED HrTCHCOCK 105 FERNDOC RD Not with t signature HYANNIS,MA 02668 Administrator �/�l// Boar` . • ui frig eg la ons an an ar s One Ashburton Place - Room 1301 Boston. Massachusetts 02108 Home Improvement Contractor Registration Registration: 158587 Type: Private Corporation Expiration: 2/8/2010 Tr# 264153 T.L. HITCHCOCK SERVICES INC. TED HITCHCOCK 105 FERNDOC RD HYANNIS, MA 02668 Update Address and return card.Mark reason for change. Address ❑ Renewal n Employment [] Lost Card :v; 0 50;A-07W-PC8490 f TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION r Map 7(0 Parcel ��" - ' Permit# Health Division �k 6 Y6 3���9� Date Issued —t'. Conservation Division 3 8 --+ Fee .26. . Tax Collector Treasurer (h�f'.��I R(Ig SEPTIC SYSTEM MUST BE �— INSTALLED IN COMPLIANCE Planning Dept. WITH TITLE 5 \ VIRONMENTAL CODE AND Date Definitive PlanApproved by Planning Board Tppdrr��p�t � W�� , -► - ,:3z� Historic-OKH Preservation/Hyannis �6� 47 " Project Street Address D.9 8 P4 2 ke ir ko-r J - Village Owner 0 aoc_•N C• So V Address ;[g 8 ?-131q4 Telephone 34 Permit Request _ _ S►�e� k0*iLf Square feet: 1 st floor: existing proposed 2nd floor:existing proposed Total new Estimated Project Cost4,a 000. Zoning District Flood Plain Groundwater Overlay Construction Type _VmT Lot Size Grandfathered: ❑Yes ❑No If yes,.attach supporting documentation. Dwelling Type: Single Family C5V Two Family ❑ Multi-Family(#units) Age of Existing Structure 5 o y r5 Historic House: ❑Yes 6-No On Old King's Highway: Q Yes ❑No Basement Type: a Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing Z new Half: existing new Number of Bedrooms: existing new Total Room Count(not including baths): existing new First Floor Room Count 'S I Feat Type and Fuel: ❑Gas &�Oil ❑Electric ❑Other Central Air: ❑Yes ❑cNo Fireplaces: Existing t New Existing wood/coal stove: RYes ❑ No Detached garage:❑existing ❑new size no Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage:❑existing 0 new size Shed:❑existing ❑new. size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes 0 No If yes,site plan review# Current Use Proposed Use BUILDER INFORMATION - Name N C�4 G1 -J Telephone Number Address License# Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE CUTA �_ DATE _ L'I 13 � • FOR OFFICIAL USE ONLY PERMIT.NO. ► DATE ISSUED " MAP/PARCEL NO. ` ADDRESS `' - VILLAGE OWNER . rDATE OF INSPECTIOTT FOUNDATION FRAME INSULATION 1 FIREPLACE ELECTRICAL: ROUGH FINAL 1 I PLUMBING: ROUGH = FINAL - GAS: ROUGH. FINAL- FINAL BUILDING { DATE CLOSED OUT �� M c ` C ASSOCIATION PLAN NO. " The Town of Barnstable Department of Health Safety and Environmental Services- " °'� ' Building Division 367 Main Street,Hyannis MA 02601 Office: 508-8624038 Ralph Crossen Fax: 508-790-6230 Building'Commissioner Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION' MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, improvement,-removal,demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. Type of Work: Estimated Cosp a 0 Address of Work: a U PAra.Ke r Zo R0 - �r<5 T►� —+� Owner's Name: N 1a,Y\ C.s. C lrUSb(1 Date of Application: �`aS Igo 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 Downer pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME Il"ROVEMENT 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 i� ne C. `s®ram Date Owner's Nfiftie q:forms:Affidav AGE INSPEC71ON PLAN �3 dog AUR MAURICE E. RIVARD do hiEATHER SOIIvINEN—RIVAR J. NANCY C. VE SON x + _S: 298 PARKER ROAD WEST BARNST MASSACHUSETTS ,EED REFERENCE: BOOK 11062 PAGE 114 PLAN REFERENCE PLAN NO. 34248—A SHEET N0. 3 ASSESSOR REFERENCE — — — LQ►� jB CLIENT FILE NO. COOP-201 DATE: OCTOBER 26 1988 FILE • M7 �" E _ N 77 I:8.00 �pI•I THING 2.0 ACRES" 9.31 t r �t - V. �m l W ' y I sisaa5a• w R0Ao . ? xit 71'►w LOCATION OF THE ORIGINAL DWELLING SHOWN HEREON. EITHER WAS IN COMPLIANCE WITH THE LOCAL APPUCASU ZONING BYLAWS IN EFFECT vlt" CONSTRUCTED (WITH RESPECT TO 14ORIZONTAL DIMENSIONAL REQUIREMENTS ONLY). OR MAY BE EXEMPT FROM VIOLATION ENFORCEMENT ACTION UNDER M-QL TITLE 7. UNLESS VD, CHAPTER 40A. SECTION OTHERWISE NOTED OR SHOWN HEREON. A REVIEW OF FLOOD INSURANCE RATE MAP COMMUNITY PANEL NUMBER__ 280= DMID DATED -2-92 HAS REWEN CONDUCTED AND TO THE BEST OF MY I NTE WA—ETAnON. THIS Dvdumo IS IN FLOOD ZONE AND IS—MCI LOCATED WITHIN A SPECIAL FLOOD HAZARD ZONE. 4 A RANDOLPH PARKMI �R., P.LS.. HEREBY CERTIFY THAT THE ABOVE MORTGAGE WSPECTiON PLAN WAS PREPARED FOR CAPE COD COOPER�ITIVE SANK ATTiDg1�tE1r JAfJES R. "LSON IN CONNECTION WITH A NEW MORTGAGE MID IS NOT INTENDED TO REPRESENT A PROPERTY LINE SURVEY. IT CANNOT BE USED FOR ESTABUSiING FACE OR BUILDING LIES. THE LAND AS SHOWN HEREON.IS 9ASED ON CLIEN- Airimm m 1brtWUA7U,.1 ,,.,� �._ ._-- r Y Application to ... Old Kings Highway Regional Historic District Committee 19 9 9 00 8 in the Town of Barnstable for a r CERTIFICATE OF APPROPRIATENESS --< ,o Application is hereby made, iri triplicate, for the issuance of a Certificate bf Appropriateness under Section Sof Chapter 470, Acts and Resolves of Massachusetts, 1973, for proposed work as described below and on plans, drawings or photographs accompanying this application for: o\ CHECK CATEGORIES THAT APPLY: 1. Exterior Building Construction: 23 New Building' ❑ Addition ❑ Alteration 1_ Indicate type of building: ❑ House ❑ Garage ❑ Commercial ❑ Other �'\e C( - -� 2 Exterior Painting: ❑ _ J J 3. Signs or Billboards: ❑ New sign ❑ Existing sign ❑ Repainting a fisting sign 4. Structure: ❑ Fence ❑ Wall ❑ Flagpole ❑ Other rj1�CC�' (Please read other side for explanation and requirements). TYPE OR PRINT LEGIBLY DATE ADDRESS OF PROPOSED WORK S �r�t�krelr �o'A� ASSESSORS MAP NO. OWNER RA'nC� �' GeIso In ASSESSORS LOT NO. C^-,(Z HOME ADDRESS aq s P�,�ke,r t`OIPi O W• �tkMl�13LC TEL. NO. 3(02 ��43 FULL NAMES AND ADDRESSES OF ABUTTING OWNERS: Include name of adjacent property owners across any public street or'way. (Attach additional sheet if necessary). 176-(8 Yl jaY�e� . �4�n5or1 Il.b_- 13 Nt�e.n LescRvlt,. 171�- ab Chan les CoamS Ill - C)O 1 rtow r; .off urtV\S-cy'Bl-c AGENT OR CONTRACTOR Sf�eDhen Ge�SOn TEL. NO. 34 �av43 ADDRESS �`�� P�r✓�e.r �OWQ DETAILED DESCRIPTION OF PROPOSED WORK: Give all particulars of work to be done(see No.S.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). 6 �) D 0 0 Il Signed rn Owner-Contractor-Agent Space below line for Committee use. ei rtific is hereby Dat MAR - 5 �ggg r 1 e BY '01004 OF B NIN~� I Approved ❑ —IMPORTANT: I Certificate is approved,approval Is subject to the 10 day appeal period provided In the Act. ADDITIONAL INFORMATION FOR MAKING AND FILING AN APPLICATION FOR A CERTIFICATE OF APPROPRIATENESS The four categories for which a Certificate of Appropriateness is required are: (application for demolition or removal is a separate form). 1. EXTERIOR BUILDING CONSTRUCTION (new or existing buildings): An application is required for any exterior of a building to be erected or altered including windows, doors, siding, roof, light etc., that will.be visible from any public street, way or public place. The following scale drawings are required in duplicate with application: plot plan (if addition -show existing buildings in outline), floor plan and elevations. Also required are snap shots of existing buildings, where additions or alterations are to be made. No plot plan is required for addition or alteration which does not touch the ground. 2. EXTERIOR PAINTING: An application is required for any portion of a building, structure or sign to be painted that is visible from a public street, way or public place. Color samples must be attached to these applications. An application is not required when repainting existing colors, changing to white,or using colors approved by the Town Historic District Committee_ 3. SIGNS OR BILLBOARDS: An application is required for any sign or billboard to be erected within the District, with the following exceptions: a. Existing-signs or billboards on November 27, 1974 shall have until November 27, 1977 to secure an,approved pproved Certificate. of Appropriateness. b.. Temporary signs•for,, use in connection with any official celebration or paradwor.any charitable drive as long as they,are'. removed within three days of`the event Certain other temporary signs that the'Committee feels does not detract from the Act may be allowed with the prior permission of the Committee: c. Real .Estate,signs of not more,than 3 square feet in area advertising ther salew rental,of-the premises.on which#They:are erected or displayed. d. A single sign of not more than 1 square foot in'area showing the,name,;occupation or address of the occupant of,the premises on which they are erected or displayed in a residential zone. 4. STRUCTURE: An application is required to build or alter any structure within the District which is defined by the Act as a combination of materials other than a building, sign or billboard,but including stone walls,flagpoles,hedges,,gates, fences, etc. GENERAL REQUIREMENTS 5. Work on projects requiring approval shall not be started until the Certificate of Appropriateness has been filed with the Town Clerk by the Committee. Approval is subject to the 10 day appeal period provided in the Act. 6. No changes shall be made from the original approved specifications without advance approval of the Commission on an amended application filed with the Committee.. 7. A separate application must be filed with each project requiring a Certificate of Appropriateness. 8. Under heading of "Detailed Description of Proposed Work" give detailed data on such architectural features as: foundation, chimney, siding, roofing, roof pitch, sash and doors, window and door frames, trim, gutters —leaders, roofing and paint color. 9. Unless application is complete and legible and all material required is supplied, application will not be acceoted or acted n. Copies of the Act establishing the Regional Historic District may be obtain ` tt �o`era• aN: , Town of Barnstable ' Old King's Highway Historic District Committee SPEC SHEET FOUNDATION _�b � 'yb 4 -tpi-Al `4 f clee p N (D�� o�•x� SIDING TYPE 130'2Y\ QIARC� COLOR C ep CHIMNEY TYPE i11-lot COLOR `+C� ROOF MATERIAL AS(Jh A v`+ COLOR W v` PITCH WINDOWS—a COLOR C-1Z k`i� SIZE o� 2 TRIM COLOR G� r Q DOORS 3 �, Y. 8 O: X U D COLORS.` �j-�e•� SHUTTERS f WO f PC v 1 "}0+' y COLORS GUTTERS b'n-4z ILA COLORS C9CC DECKS S MATERIALS $PRrI GARAGE DOORS CIA COLORS SKYLIGHTS n �� SIZE COLORS SIGNS t�. ` COLORS FENCE h tR 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. • SPECSHT Revised 11/98 �33�07 MORTGAGE INSPECTION PLAN `ill 4 f'R OWNER ROWER; MAURICE E. RIVARDdc HEATHER S011vit�{EN—RIVAR BUYER: NANCY C. GEI'.SON .� °N ADDRESS: 296 PARKER ROAD WEST BARNSTABLE, MASSACHUSETTS GEED REFERENCE: BOOK 11062 PAGE 114 Ao PLAN REFERENCE: PLAN NO. 34248-A SHEET NO. 3 1 ASSESSOR REFERENCE - - JO&8S CLIENT FILE No. CCOP-201 DATE: OCTOBE'R 26 1995 Q . F! 9 -- 0• N 77�gpgb 44' E N 77!Wog» F N 77'I 33.83 N 7 9'37" E k, �•00 EOM 1fsING 2.0 ACRES q 3 4F f ` R,.118g 58. �7O g4 ROAD P A it 7Hw LOCATION OF THE ORIGINAL DWELLING SHOWN HEREON. EITHER WAS IN COMPLIANCE WITH THE LOCAL APPI,ICAgLE ZaVNG BYLAWS IN EFFECT WHEN CONSTRUCTED (WITH RESPECT TO HORIZONTAL DIMENSIONAL REQUIREMENTS ONLY). OR MAY BE EXEMPT FROM VIOLATION ENFORCEMENT ACTION UNDER M.G.L. TITLE VII, C.4APIER 40A. SECTION 7. UNLESS OTHERWISE NOTED OR SHOWN HEREON. I A REVIEW OF FLOOD INSURANCE RATE MAP COMMUNITY PANEL NUMBER,.,_ 250M MID __ 1 DA'TED,, 7-2-92 HAS BEEN CONDUCTED AND TO THE BEST OF BAY INTERPRETATI&4 THIS OV01 NO 15 IN FLOOD ZONE C•..�,. AND IS.,—NQJ LOCATED WITHIN A SPECIAL FLOOD HAZARD ZONE. 1, a RANDOLPH PARKER, JR., P.LS.. HEREBY CERTIFY THAT 'THE ABOVE MORTGAGE INSPERM PLAN WAS PREPARED FOR _ f:APE COD gg2MT1V,E BANE: & ATTORNEY JAIJES R. WILSON IN CONNEC710H MH A NEW MORTGAGE AND IS NOT INTENDED M REPRESENT A PROPERTY LINE SURVEY. IT CANNOT BE USED FOR ESTABl.ib71ING FENCE OR BUILDING LINES LAND AS SHOWN HEREON IS BASED ON CUEN- FURNISHED INFORMATION AND MAY B£ SU6�lE S. 'TCT TO FURTHER OUT—SALES, TAKINGS, EASEMENTS AND RIGHTS OF WAY. NO RESPONSIB1UTY IS EXTENDED HEREIN TO THE LAND OWNER OR OCCUPANT. THIS INSPECTION PLAN WAS PREPARED BY USING CURRENT GEED INFORMATION. •M�wwM w. �•.w wlAww N, ' 1541177 197 153 176 196 152 175 195 o 000 or CL 46 Lu IN cr- < D w cr CL ed .6i co va� fo CL it CO Hot 1 CID P rucE LL Pond z 'l * 'r�*'� ,'.•��-'i]� t � i/8'a'-l2'S�Ittioe w/al�tionai't�'�rti�virid��v andycupola.� { 0- � Y Yam- l Lfl•��j r 1k 7 lM '� M 1 •11 04.1 i jl 4,:J•y s �!4. � 1 o r w 5 1 • . Clgx Ccd y ' • MIA I i I �00 PRO9�� : i Since 1980 Pine Harbor Mood Products has built thousands i. of post and beam sheds throughout New England. Our family owned and operated business would be pleased to quote you on one of our designs or custom design of your choice. 0 All of our quality crafted storage sheds are full dimensional, sawmilled pine. We deliver and construct our products at an ' affordable price and on schedule. Sheds are precut at our shop and usually assembled in one - day on your site. Ms Thank you for your interest in our post and beam buildings. Please call us for more information. Our post and beam sheds are built on your property.Our standard sheds come with: , •Concrete block •.Handmade oak handle •5/8"plywood floor •2' x 6' Pressure treated floor FramingIM • Ramp •Stationary window I ' e r • Post and beam frame •Shutters and flower box •Board and batten siding •Asphalt shingles •36"door • 8"x 12"louvers for ventilation •Heavy duty hasp `• Available options to further customize your storage shed: y r • Double Doors •Extra Windows = ^ •Higher roof pitch •Longer Ramp •Double hung windows •Loft •Cupola • Cedar shingles •'' -t_� •Cedar clapboard •Sona tubes •Work Bench •Shelving Give us a call for pricing on options. • Please check with your local building department regarding permit requirements, setbacks and other regulations that apply. • Payments are due in full the day of delivery. Credit card sales must be processed before the delivery. No exceptions. • We ask that you properly prepare the site location on which the shed is to be constructed.Trees,shrubs, and miscellaneous items - need to be removed before we arrive to do the building. • Please notify us in advance if the site you have chosen is not WARRANTY accessible by truck, or is in excess of a 50 foot distance. Sheds Pine Harbor Wood Products provides you with a Limited ited Otte t I 1 are built on location for your convenience. Year Guarantee against detective materials and workmanship. •All sheds come in natural pine. We recommend staining after Damage by accidem.neglect or natural disaster is not included in this guarantee.`rhe warranty period begins upon completion of construction to preserve the wood. construction. �p h. - -- 40 NZ O - (� 244 P; - 0 1 1' 2 TFTT Al MG I Al — - _... - ._..__.._.. _.. f.._..._. .... -.. _. Id LLD f - � NL g c�- a8 x 1'2;Saltbox H/o ti6' I"ztra window and a ola.: '� .� �'`+�••-�...r'r����.+H�� S• �`� . 1,�F`�l�tl • Ir 1 ����;�r� -�' �1 .���y ..����;4 �i s �Yf ��i� ��y w � • wsti, s""�`f•� ��T1 y �'1'E;.1 `• •i !./ .. Lf�.-. .sy7'q �✓:,•„ ���` ,l�n■ •F�i�+',� ti ~r` ;-f 'Rir 1�y ..t '` f' ,f 1.J -• --..rl..-+7J�, 'i `Vw i ' " ati'�' : ''� ,�'`,. �.-• ��--y'G � ,G�G ..ate- `� L a s To a\W to It _4r� a : : • 1 � t l '::T 4 d N of 1 lob . Capc Cud � 1 •1 1: � 1 �11 •• •• �� �� li 11 ill • 6 1 H�e0 OOD PRO��� ,i Since 1980 Pine Harbor Wood Products has built thousands of post and beam sheds throughout New England. i+ Out-family owned and operated business would be pleased ! t to quote you on one of our designs or custom design of your choice. • All of our quality crafted storage sheds are full dimensional,' sawmilled pine. We deliver and construct our products at an $` affordable price and on schedule. 4 Sheds are precut at our shop and usually assembled in one V - day on your site. Thank you for your interest in our post and beam buildings. ``f � Please call us for more information. Our post and beam sheds are built on your property.Our ` standard sheds come with: •Concrete block •Handmade oak handle `': , Jul LZ •5/8"plywood floor •2' x 6' Pressure treated floor framing •Ramp •Stationary window ' •Post and beam frame •Shutters and flower box w •Board and batten siding •Asphalt shingles •36"door • 8"x 12"louvers for ventilation •Heavy duty hasp +. ..».4,•c -r v ` O A Available options to further customize your storage shed: •Double Doors •Extra Windows •Higher roof pitch •Longer Ramp •Double hung windows •Loft •Cupola •Cedar shingles •Cedar clapboard •Sona tubes e •Work Bench •Shelving Give us a call for pricing on options. y _ •Please check with your local building department regarding permit requirements, setbacks an'd other regulations that apply. - •Payments are due in full the day of delivery. Credit card sales must be processed before the delivery.No exceptions. •We ask that you properly prepare the site location on which.the t shed is to be constructed.Trees, shrubs,and miscellaneous items need to be removed before we arrive to do the building. •Please notify us in advance if the site you have chosen is not WARRANTY accessible by truck,.or is in excess of a 50 foot distance. Sheds Pine Harbor Wood Products provides you with a Limited One(1) are built on location for your convenience. Year Guarantee against defective materials and workmanship. f All sheds come In natural pine.We recommend staining after Damage by accident,neglect or natural disaster is not included in • this guarantee.The warranty period begins upon completion of construction to preserve the wood. construction. - 600 �� • �t:KeeG` Boston, Mass. 02111 Workers' Compensation Insurance Affidavit dlicant information •, __ - = Pfcs�sc�'Rfi'`IrTeE _ _ _.. .._..,...' T'....,._, .i;r `•ir�.,'�q;� o�=:o•oi�ez O Nucil, W {�'(ZNS�A��-� ZCo G'Fs phone e -3(oa a-04 3 O 1 am a homeowner performing all work-'myself. O I am a sole proprietor and has•e no one working in ans capacm l am an employer providing workers compensation for m\ employees working on this job: l D fs?1slAtnn name 1'(ZCT (M 0(�Q D A ���H�1✓bntr ad ireee ��� �a nine �Llad / iil t-t�GY1�iS � p - ot,onea (S�g �'7/ -S'Oo7 Urince co. 1 (�n• policy 0 UJC3S13 ?G (,OS _ ,• _ .. . -•y—.. _ _ _ ,•c, ,.•.err� �^�•^—.�...+s;c• O 1 am a sole proprietor. general contractor,or homeowner(circle one) and have hired the contractors listed belo%% aho have the folio«im;workers* compensation polices: L41�Stans•n. -addre ` , t phone it: _ polies•� in,urance co. v. ..~ t��'i.. :fir. r ._.+� : !..-. �v.. ML w�1►. OhOIIe�' U Insurancec0 vortex ff 11Cliad0a�f�t�1� e or Failure to secure coverage as required under Section 25A of�tGL 152 can lead to the lmpostaoa o[entatau penalties as i rue ep..+adcr-s.it "' one years'imprisonment as well as civil penalties io the form of a STOP WORK ORDER and a tine of 5100.Q0 a day against me. t aadecstassd ttsat a copy of this statement may be fomardcd to the Office of lnvestigatioas*of the DtA for coverage verification. t do hereby certify under the pains and penalties of perjury that the information provided above is(ru(t/and correct Signature Date Print name N fl N C C �'t S�'" Phone a 3C. Z -Zo 43 :- offcial use only do not%rite in this area to be completed by city or town official � city or town-_ - _ _ permittlicense M t Building7DcpQLicensinrd O check if immediate response is required �licalt Department rtmen I �1{ealth Department phone a:_ — nOther_� contact person: - Bunaing vivision BARMABLE. ' 367 Main Street,Hyannis MA 02601 _ MASIL Office: 508-8624038 Ralph Crossen Fax: 508-790-6230 Building Commissioner HOMEOWNER LICENSE EXEMPTION Please Print DATE: L l JOB LOCATION: a1Q p, o-P4 l�l . I ox o s-i-A-F, dt number street village. "HOMEOWNER": hy1 C Q. �Je. 3(0 _ae9 5 name j home phone# work phone# CURRENT MAILING ADDRESS: 5P yh 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 su ep rvisor. 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 1esponsible 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 Hc6cowncr 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 formicc tification for use in your community. QfORMS:DEMPT 1 SHEDS (greater than 120 sq. ft.) If located in OKH or Hyannis Historic District- Certificate of Appropriateness is needed Map/parcel number Sign-offs from: Health Conservation Tax Collector Treasurer Owner's name & address [� Shed Dimensions Estimated Cost ❑ Complete dwelling information for the Assessor's dept. Applicant's telephone number Plot Plan Two sets of plans with cross section I Workman's Comp. form I Home Improvement Contractor's Affidavit Construction Super's License AND Home Improvement Specialist's License OR Homeowner's License Exemption form. ❑ Check expiration date on license(s) ❑ Check expiration date on license Fee S: NOTE SHEDS 120 sq.ft. or less - (RESIDENTIAL AND COMMERCIAL),do not require a Building Permit BUT Registration form and Plot Plan are required ❑ If located in OKH or Hyannis Historic District- Certificate of Appropriateness is needed PLASTIC,FREE-STANDING GREENHOUSES DO NOT REQUIRE BUILDING PERMITS. q-forms-PERMITS 1 Rev 6/2/98 Assessor's map and lot number .1./.. 6. SEPTIC SYSTEM MUST BE` INSTALLED IN COMPLIANCE .�, '! d V.]TH A771CLE II STATE Sewage Permit number ......................... .:............................. SANITARY SANITARY CODE AND TOWN yo�T�Eto�` TOWN OF BARN 9'fXft— _._.__ • BAHH9TdBLS, i "6 DUILDONG INSPECTOR APPLICATION FOR PERMIT TO .a......�� `�� `-............................. TYPE OF CONSTRUCTION .... .... c t............:....................................................................:..:.................... f°..f ............................ TO THE INSPECTOR OF BUILDINGS: The undersigned .hereby applies for a permit according to the following information: Location ......Pie.k.K 9.:.....VUJ. } ..,.......(, c�..T......6494CQ.S,18-.&.�k......................................................... Proposed Use ........ Zoning District ..4....4�_�e 5 -: 0.1�1.N..� .!V........Fire District ..�GS T.�����4'1�.�.��''.!�l G�............. `�� .. �� ds✓' r� 1...�.!�.....lam. ..�,9�C'i1�, �[C Name of Owner..._ '�'. /.! !. r ................Address >� Nameof Builder .................................Address ........ :. 1............................................................. Name of Architect ..t��:...Address ./ �� ✓�� Number of Rooms ................... ......................................Foundation ..... OLr....��................................................. Exterior �E .. 5 � :. .. r�...............Roofing ....r��e,. Isz' . .1i��!1��''1� .�5......... V -� E 7G� Floors !....................U.....................................................Interior ......... .. .... + I Heating .....� ...................................................................Plumbing ....../......... :.....:./ 1 1... .. ....................... Fireplace Approximate Cost Definitive Plan Approved by Planning Board -----------_______-----------19_______. Area 4,,d.. Diagram of Lot and Building with Dimensions Fee ..................................® a . SUBJECT TO APPROVAL OF BOARD OF HEALTH I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. .,......� C Name �- rCi....,1.. ....... Sm��wo P. �- � ! ! ' ` / No ������ Permit ' —' ' --=��`=`t�*�--' ................ - -------------.. | , _ � p� Parker Road Location . ----,^----=--,^-------- ' ^ West-.Barnstable � ^------------'---''^'--------' ^ Owner ---.. 'P�_�oir���en_____.. ` ' . frame Type of Construction -------------- --------------------------. plot .��— .. ��'------' ................................ . . ' . ~ - . _ . --- of Inspection Do'o Completed / V17 q ` . . PERMIT REFUSED r , ' -----.------.'—. .' ---- l�. --..� ~ � ` | ------------ ---------�---- / �� � ^', / ��l� J�~ � _—... .�--.���------.-----------. | .------------.--------.----- ----.-----.------.--..------.. - x ` � Approved .................................................. 19 ' ` ^ ` Assessor's map and lot number ......7 // // �. �/ /' //, SO...........,1....... ....... � THE c r- G ' �T SYSTE COMU �oF � IC Sewage Permit number ..J� .. . . ....�. ✓� INSTALLED IN / ST B P L PLIA 7 7- WITH A RTICLE Z �EA"STADLE, . I STATE House ;iumbIL Ger ...��. ............................................................ SANITARY EO.DE AND T rb REGU Q. 39 �0 _ATI.Q'NS. �-�" '�0 wav a. TOWN OF BARNSTABLE V Y' BUILDING INSPECTOR APPLICATIONFOR PERMIT TO ........... ...... .. .... ....................................................................................... N TYPEOF CONSTRUCTION ................................ .................................................................... ................................................19........ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according o�to�.the following information: Location .....rX.../...+?F..... ......(? ........., !..:...... ..................... .......... .................................................. ProposedUse .v.... ..................... ...................................................................................................................... Zoning District .....F Fire District . ..... ..... .. . .. .. . .. .... . .. .................... Name of Owner .......... .. .... ...... ....Address t-49T... ..11 ...... to Name of Builder Address..... /.. �. J6!? r►� a-C.� Name of Architect %60 , . ........................ .............Address .. .............................. . Number of Rooms ..................... ..........................................Foundation a-w?-4 ... . ..... . ..... ...........64 .... '*�`!� Exterior G�f!?J . . ..y:. .. ..Roofing a .... .. . .. . .. ... ���� g Floors . ........................................................Interior ��.... Heating ....................Plumbing ..................... ........................................................ Fireplace ?-............................ Approximate Cost ... Definitive Plan Approved by Planning Board -----------_______-----------19_______. Area Diagram of Lot and Building with Dimensions Fee .......)/t................. ................ SUBJECT TO' .P O.VAL OF BOARD OF HEALTH h _ e-z p i- G ``rto'GH/N C P/r5 I hereby agree .to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name . ......... .... .............. Soinonen, Seppo No 20297 Permit for add t. ...o single ..... . ............. family dwelling ............................................................................... Location .....298, parker Road West Barnstable ............................................................................... Owner Se .po..Soinenen Type of Construction .........frame...................... ............................................................................... ' Plot ............................ Lot .........................:...... 9 Permit Granted .........June...12................19.78 ©�6/2.�- Date of Inspection ........ .. y...... ..........19 j p l9 Date Completed 3E' �f PERMIT REFUSED ......... ..... ..................................... 19 ............................................................................... ...... .... ..................................................... ..... ................................................ ......... Approved ............................................................................... .................... ............................................. . Assessor's map and lot number ......7.1...............�.�......... o�TNEto r ,�- ' Sewage Permit number ......� .' ..`� .�s �t'+��-w/.,•.. ?.ems i,f r►-1 "' e�Q� ��� ............ ............................. BAHB9TODLE, i House number ........... y NAB& .................... ............................... 00 i639 9��OYPYa` TOWN OF BARNSTABLE BUILDIrNG INSPECTOR L t APPLICATION FOR PERMIT TO ...........!ZJ,-ar;/............................................................................ TYPE OF CONSTRUCTION " ............. ...............................19........ TO THE INSPECTOR OF BUILDINGS: / The undersigned hereby applies for a permit according to the following information: Location ....r.. � 7 \. � �j Chi . y�...... ................... -`- ::............:............................................ ............................... ...... ,Proposed Use —�2 ........... ............................................................................................................... r Zoning District �'.........................................................Fire District .).. . ... ......................................... Name of Owner ,i��a /.. ':- - -�-r* Address .....z &..��.- f v / Name of Builder ���! ,� ..�E ... - , F ! !. ......Addressf.��..©,. ! „ ate c�.:...�1. .... ......... ........... .... .. Name of Architect ... ......., Address Number of Rooms .................................................................Foundation --/.......rt:���.... ,O Exierior.� 9n r_ a.. / �i �P• ��...Roofing /,! , , ..............................:................ Floors .-��!-!� .Interior !?. �� *� !�....................................................... ..... Heating !- .... rw...� a ..........Plumbing Fireplace .-........................................................................Approximate Cost ' Definitive Plan Approved by Planning Board -----------_______-----------19_______. Area L!?!; v (j Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH o I � � p I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name0...... <,Z.�'- - %i-c.. ................... Soinonen, Seppo No 2029.7....'Permit for ......add...t.o..s.i.ngle.. ........ . ...... . .. .. . ........ st family dwelling ............................................................................... 298 Parker Road Location ................................................................ `West Barnstable ............................................................................... Owner .........Sep.p..o......S.o.inen..e.n ...... .......................... . ........ .. Type of Construction ........frame...................... ....................... Plot ....................... .../. Lot ................................ June 12 78 Permit Granted ........................................19 Date of Inspection ...................................19 Date Completed ............... ......................19 PE IT REFUSED .......... .... ....... . 9......................... 19 -T. ..................... ...... ..... . ..... ................................. ........... ... .... . .. .................................................... ............... ........ ........ ........... ...... ....... .6D ............. ►.. .......... ...... ............................. Approved ................................................ 19 ................................................................... ........... ...............................................................................