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0353 WILLOW STREET
r T7�j r � , NO. 1521/3 ORA MADE IN u.&A. i$1 ESSELTE (�S 7�4 �- -- {� � �' vv ��,--�� U� ��, �, r--_ �� ��� 02 �f �� � � l���,�" ,. �� �THEtp� Town of Barnstable *Permit -I - �J Building Department e 6mo the omisA e BAMSTwst.E, : Brian Florence,CBO �� v� 1639. 10� Building Commissioner prfp act A 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERNUT APPLICATION - 'RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number r' , Property Address 3 S3 W .��� Kl&f a ryl S �P MA Residential Value of Work$ d 00 Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address woes J.e s � 3�S �L Contractor's Name Telephone Number SZ�g :3 G q � Z�5-- Home Improvement Contractor License#(if applicable) Email:���;�L-\�(Si EN (9 �tw�cc �1'•4V et" Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance �a�• �' Check one: D ❑ I am a sole proprietor EC 44 201 I am the Homeowner o IA p I have Workeris Compensation Insurance 1 �� Insurance Company Name �0.�tM �cQ.tM� 1 �/ �� . �g=t� � Workman's Comp.Policy# Copy of Insurance Compliance Ce�te%ust accompany each permit. Permit Request(check box)Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to Qz! S e-roof(hurricane nailed)(not stripping. Going over existing layers of roof) Re-side ❑ Replacement Windows/doors/sliders.U-Value (maximum.32)#of windows #of doors: *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 oft he Home Improvement Contractors License&Construction Supervisors License is required. SIGNATURE: �- Q:\WHILESTORMEXPRESS2017 . 27ze Coanvromvealth ojfMassaclrxsetts Department cr,fIndus&ial Acciderds Qffce afbznestigatians ' 600 Washington Mz get -- Baston,AA 021'II -- ><w iu masagovIdia Wmimrs' CompensatianInsn-auce Affidavit BaderslContractcxrsMectrieians/Phunbers Applicant Infarma{ on Please Prat ETaIY Name(B WMJ01ZqWjMfi Addresr • r '©ZGG� • Cityl atef Phone 3 G `< Are you an employer?Checkthe appropriate barm ' Type of project(r I.El am a employer-with 4. I am a general contractor and I 6. ❑New oons�ut-Finnlion employees(fall andfor par�4ime}* have ltimdthe sub'cont actors 2.❑I am a sale propdetor orpartner- listed onthe affached sheet 7. ❑Remodeling ship and have no-employees. These sub-confractas have 8..❑Demolition wordaag forrne in any capacity. employees and have wo&.ess' 9. ❑Builcung addition [No updoa S' comp.insurance comp_mcnrzaml Eqnr 5. ❑ We are a corporatim and its 10-❑Electaical repairs or ad&tions officers have esercised their 1 L❑Plumbing repairs or additions 3., am a liameo�er doing all wa�rk n P myself �F 1�7 oi' o workers' right of emampfion per MGL repairs , ce ewe&]i c.152,§In andwe have no employees.[No wadners' 13-0 Other conq-insurance required_) 'Arzyapply=Cat checks box rl— also fMauttheswffanbe7owshosougdeirvaAe 'compms+fio*paricyinEMMMaca' Someownemwho submit dos afiid2v$;rgffczt g&E!yaxedin-Own*gad&enloneG=deconhxcMrswTn such_ ZooaGsci. iTt ebec3rthisboatn4>tstachedanad slsheetshaa�gthen:meofttes¢bc s�clsta�whetbsarnott�nseeoiit hs� explayees.ifthesnh-c=tzctumhxce employees,theymustpmvide&eir trarkeis'comp pd1ky number. .Tam an ,BeFaav is i1ier paNcy and job site information. Insurance Company Name: %0 V-VVN. �0"��1•� Po&cy Cr in, I.ic_,f �r!off I ExpirafionDate: p p Job gi a Addrem 3SJ �, I ul CdylStafel2ip: �i(l�+ !Ul/I� d-C-G 6 Attach a copy of the worbers'corapmsationpolicy-declaration page(showing the policy number and e=piration date). Faihm to secure coverage as requiredutider Section 25A of MGL c 152 can lead to the imposition of criminal penll% s of a fine up to$1,SOQOD andror one- earimprisormenk as weIl as civil peuahies m the form of a STOP WORK€RDERand a fee, of up to$251DO a dap against the violator_ Be ad-iised that a copy of this statement maybe forwarded to the Office of Itavestigations ofthe DFA for insurance coverage verifwtism I&hereltp T nu Lar tkspains and rabies afparjrur3'fliatflie iiifarmcdiauprm=rrled abms is bars acid correct Signature Date. Phone ik J O,iial use anfy. Do nat tvrke in this area,€a be cmripfeW by clip ortnnrn afficiaL City or Tan n- Permiff icense if Lwaing A oritty(circle one): L Board of Health 2.lBuaTdng Department 3.CiiyMown Clerk 4.Electrical Inspector S.Phunbing Lmpertar 6.Other Contact Person: Phone 9: — -- — 6 ormation and fastractiolas Mzcc�smtfs General Laws chapteix IS-2 regaffes all employ='to Provide wows'compensation for their employees. parsaantto this sty,an rn47Ioyee is defined as.,-every person in the service of another under any corset ofliur., espMss or implied oral or wlateu.f An mT&Yer is defined as`ran inavidng partneashp,associan,crnpm- on or other legal entity,or arty two or more of the faregomg engaged im a Joint use,and i achidmg the legal jupL enbflves of a deceased employer,or the receiver or trustee of an mdividwil,paxtrLmship,association or other legal entdy,emplaymg employees However the owner of a dwelling horse having not more than three aparimeofs andwho resides therein,or the octet of the - dw U5ng house of anofher who eaiglays pmsms to do make,canstruction cr repair work on such dwelling hose or on the grounds or bm7dmg appmtenanftTiereto shallnotbecanse of sarh employmentbe d=ne;dto be an employer." MC3L chapter 152,§25C(6)also states chat"everystat$or local Urxasmg agencY shall withhold ffie issuance or renewal of a license or permit to operate a busimess or to construct buildings in the commonwealth for any applicantw•ho has notproduced acceptable evidence of compUance with the msarance.coverage required" Adationally,MGL chapter 152,§25C(7)states-Neither the caffinauwealth nor guy ofits political subdivisions shall ems into any conttaot for the pP'f rm a=ofpnbIic work=E acceptable evidence of compIiancewith the m so c-c.. reTuireoien is of this dnpt�r have been presented to the conft ting aufho�dy." APPti�� Please fM out the wo&m'compensation affidavit completely,by checldng the boxes that apply to your situation and,if necessary,supply sub-c� s)nmne(s), and PhcIIemmmber(s)alongwiLtheir certiFacat (s) of insurance. LmmitedLiAffityCompanies(LLC)orLimitedLiabi y-Parf immbips(LLP)withno employees other.than the members or pariners,are not regtmYd m cony workers'compensation inso rance. If an LLC or LLP does have employees,a.policy isreqoired. Ba advised that this affdaykmaybe snbmitfedto the Depa-traent of Industrial Amideufs for conf=afm of insurance coverage Also be sure to sign and datethhe affidavit. The affidavit should be-retrm (-,d to the city or town that the application for the pezmit or license is being requested,not the D ep artmeaf of . Ladn ctrial Accide:s. Should you have any quint=regarding the law or if you.are required to obtain a workers' cop ,,ti poHcp,plmsec&UtbeDepartmeotattbemmnberlisiedbelow Self-fiLmnedcompanies should enter their s elf-insuraance license member as the agpmptiate Ime. City or Town Otizcials . r - 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 tD frll ouf in the event the Office oflnvestigatiaw has to comactYou regarding the applJ.�nfi wiIl be used as a reference ffim Please be sure to MI in the pennhIlicrose comber which ber. Iaffidavit intlicaiiag cusent addition,an applicant Boat must sabmi t multiple p emlit/Iicense applications in auy given year,need only submit one a Bo p olicy infonnation(if nxessary)and under`Job She Address"the applicant should write"al[locations in (�Y or awn)."A copy of the-affidavit that has been officially stm aped or marked by the city or town maybe provided to the ' applicant as proof that a valid affidavit is on file for fatoie"p=its or licenses Anew affidavitm ist be filled of each year.Where:a home owner or citizen is obizi�g a Iicense or permit not related Pa any business or commercial vmb= (i-f,-. a dog license or pemut to bum Ieaves etc.)said person is NOT req¢aed to complete this affidavit The Of of Investigations wouldIrkeIo thankyouin advance for your cooperation and shouldyou have any,goestiam, please do not hesitate to give us a call. The Department's addrsss,t6lephone and fax nnmber: - Tha Cz��Iwed*el& ch> - Dega t nent cif 1u6istda1 AwidentEt f mca of bi Pith°- BWL033..,MA 0�111 Ta#6177 --4900 cmt 4-06 ar 1-977-MA&i ACE Fax 9 627'277749 Re- ised4-24-07 ww l 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)::ztt Address: City/State/Zip: Gv, Phone#: � Are you an employer?Check the appropriate box: . Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2. [1 I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g, ❑Demolition working for me in any capacity. employees and have workers' 9. ❑Building addition [No workers' comp.insurance comp.insurance. t required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their I L❑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 employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: /n ,// / v Job Site Address: t.,�-3 /L/e°41C.1 � City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 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 certify er the pains and penalties of perjury that the information provided abo a is true and correct Signature: Date: Phone#: Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: 5 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 bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington.Street Boston,MA 02111 Tel.#617-727-4900 ext 406 or 1-877-MASSAFE Fax#617-727-7749 Revised 4-24-07 www,mass.gov/dia i -LVVV11 VA ""A oFTHE Tp , Building Department ti o� Brian Florence CB0 1 Building Commissioner • BAMSTABIE, • v MAC $ 200 Main Street, Hyannis,MA 02601 ArFn Mpl° www.town.bamstable.ma.us I • Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION' / f Please Print DATE: R JOB LOCATION: s, 1 ilk L A 0S t w e$I' dJ N S f 0. number �) street village "HOMEOWNER": ctl IM2C 1V yt c t1S 68 name ' ,l. home phone# work phone# CURRENT MAILING ADDRESS: .5 W rs F LA �'f )P St- 45Nn eta /� � M city/town state zip d The current exemption for"homeowners"was extended to include owner-occnpied.dwellines 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 responsib e perm le for all such work performed under the buildinit. (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 um inspection and requirements and that be/she will comply with said procedures and uirements. Si atlue of Homeowner ' Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors); provided that if the homeowner engages a 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 to amend and adopt such a form/certification for use in your community. �oFt„E ram, Town of.Barnstable � do Building Department • s"�16TAB Brian Florence,CBO 16 ��� 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 Builder I, w1 eS _y��,•- ,as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application for: AS-3 W, l( -uj Us & rA AA 3 (Address of Job) **Pool fences and alarms are the responsibility of the applicant Pools are not to be filled or utilized before fence is installed and all final inspections are performed and accepted. afore of n Signature of Applicant ��Vy S�'►n. Print Name Print Name Z A4 Date QTORMS:OWNERPERNII.SSIONPOOLS Rev:10/17 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY INFORMATION PAGE Farm Family Casualty Insurance Company °0 01--t.r4—York AGENT NO 3020 OFFICE NO 3020 MARK SYLVIA INSURANCE AGENCY LLC Farm Family Casualty Ins.Co. 404 MAIN ST CENTERVILLE MA,02632-2916 NCCI COMPANY NO. 16721 508428-0440 POLICY NO 2001 W6073 _TIW:L INSUIIED`:'::]INSURED AND MAILING ADDRESS: RenewConversion JAMES N JENSEN EFFECTIVE 08/09/2017 353 WILLOW ST WEST BARNSTABLE,MA 02668-1363 THE INSURED IS Individual Workplaces covered by this policy: ST WP NO. ADDRESS OF WORKPLACE RTG.BUR NO. INTRASTATE NO. MA 1 353 WILLOW ST w W BARNSTABLE MA 02668-1363 N .. TTEM 2.POLICY PERIOD. The policy period is from 08/09/2017 to 08/09/2018 12:01 A.M.Standard Time at the insured's mailing address. ITEN11COVERAGE. A. Workers Compensation Insurance: Part One of the policy applies to the Workers Compensation Law of the state listed here:MA B. Employers Liability Insurance: Part Two of the policy applies to work in each state listed in item 3.A.The limits of our liability under Part Two are: Bodily Injury By Accident Bodily Injury By Disease Bodily Injury By Disease s 500,000 each accident $500,000 policy limit $ 500,000 each employee C. Other States Insurance:Part Three of the policy applies to the states,if any,listed here: All states except the states designated in item 3.A.of the information page and ND,OH,WA,and WY D. This policy includes these endorsements and schedules: X49710416 X30781208 WC750506GO202 X43320216 X2729 X3632 X36560813 WC000001A WCOOOOO000115 WC0003150985 WC0004040484 WC0004140790 WC000422BOI15 WC2003010494 WC200302A0908 WC200303DO810 WC2004011190 WC2004030191 WC2004050601 WC20060 I A0708 WC2006041102 I Copyright 1987 National Council PROCESSED 06/19/2017 on Compensation Insurance WC 00 00 01 Issuing Office-PO Box656-ALBANY,NEWYORK 12201-0656 2001 W6073 06-19-2017 20:19:32.0C Farm Family Casualty Insurance Company x ulenmont.Now York WORKERS' COMPENSATION MASSACHUSETTS CONSTRUCTION CLASSIFICATION PREMIUM ADJUSTMENT PROGRAM APPLICATION Insured:JAMES N JENSEN Federal Employers ID No.: 353 WILLOW ST Address WEST BARNSTABLE MA 02668-1363 City State Zip Policy No.2001 W6073 Effective Date 08-09-2017 Carrier Farm Family Casualty Ins. Issuing Office 3020, 404 MAIN ST,CENTERVILLE MA, 02632-2916 Notice: Unless code(s), total wages paid, total hours worked, calendar quarter reported are indicated and application is signed, it,cannot be processed. Contact your agent if assistance is desired. ;CLASSIFICATION(S)4�, CODES„ '` Y TOTAL`- TOTAL•HOURS '1VIASSACHUSETrT 44 WORKED t .� WAGES P,AID,1 s The foregoing is based on actual wages and hours worked, as reflected in our payroll records, for the complete calendar quarter ending Excluding overtime premium pay. Signature Position Date X-3656 0813 2001 W6073 06-19-2017 20:19:32.0C YOU WISH TO OPEN A BUSINESS? +' F 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,a 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 required by law. DATE: S Fill in please: ixn= � APPLICANT'S YOUR NAME/S: e s A J�v`se-v` BUSINESS YOUR HOME ADDRESS: 3 l v- 9F? . ass ' TELEPHONE # Home Telephone Number 76 R Z T=r3 t l D NAME OF:CORPORATION: NAME OF NEW BUSINESS' Q: �.v�sevt TYPE OF BUSINESS IS THIS A HOME OCCUPATION? < _YES NOS^ sc4 ac.s ADDRESS.OF BUSINESS.2�3 W,1(our S-r 10 M* MAP/PARCEL NUMBER. Io 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 COM SIO ER'S OFF CE MUST COMPLY WITH HOME OCCUPATION This individu I ha n infra e f p r it requirements that pertain to this type of business. RULES AND REGULATIONS. FAILURE TO MAY RESULT IN FINES Aut oriz d e* MENT ' U JTV E —41 �l 2. BOARD OF EALTH 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: i Town of Barnstable Regulatory Services �T T o Richard V. 5cali,Director BAENSTABLFa Building Division MASS.� 3q Paul Roma,Building Commissioner i6 . >�0� 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us' Office: 508-862-403 8 Fax: 508-790-623 0 Approved: Fee: Permit#: HOME OCCUPATION REGISTRATION Date: . i /Z� Name: ____S D.cnn�e_s y, v" Phone Address: Village: Name of Business:4„vim! :::9VnSg '6_ t J P Ks.fl v\_ Type of Business: ��d �„,�r c nY kr kc-21; 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 unde ' ed,have read and agree with the above restrictions for my home occupation I am registering. Applicant: / Date: 34 Z 0 (F Homeoc.doe Rev.06/20/16 i l Engineering Dept. (3rd floor) Map Z& Parcel Permit# House# Date Issued 9!O �Fee b'1 1NE/p�;_ -Y- pa � /�L/ 19 : �A"l�s� jrojj // G--S 6 /` � MASS.yOWN OF BA S ABLE °"Building Permit Application reet Address 3 5 5 124 60 Village�� � ti :� Owner ��irv�� . ,��,y1e �f Address Telephone 56-9 3 Z -Z t 0 3 Permit Request First Floor square feet Second Floor square feet Construction Type Estimated Project Cost $ /.5 00 Zoning District Flood Plain Water Protection Lot Size Grandfathered ❑Yes ❑No Dwelling Type: Single Family a Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House ❑Yes ,p No On Old King's Highway des ❑No Basement Type: ❑Full ❑Crawl 01(alkout ❑Other Basement Finished Area(sq.ft.) s� Basement Unfinished Area(sq.ft) Number of Baths: Full: Existing `7 New Half: Existing New No. of Bedrooms: Existing `{' New Total Room Count(not including baths): Existing -7 New First Floor Room Count 3 Heat Type and Fuel: ❑Gas Oil ❑Electric ❑Other Central Air Yes PfNo Fireplaces: Existing ?-- New Existing wood/coal stove ❑Yes MNO- 11, Garage: Detached(size) oZ y ,�,.� Other Detached Structures: ❑Pool(size) a ❑Attached(size) ❑Barn(size) ❑None ❑Shed(size) ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes �No If yes, site plan review# Current Use Proposed Use / Builder Information Name 1/0 4 �/Q�n f��� Telephone Number Address &a License# 00 S 4l0 9 Home Improvement Contractor# Worker's Compensation# "302-0 NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT) SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO X 1k aC 'li SIGNATURE DATE (( � z z BUILDING PERM DENIED OR E FOLLOWING REASON(S) FOR OFFICIAL USE ONLY ,+ f- t. 7 PERMIT NO. DATE•ISSUED MAP/:PARCEL NO'- ADDRESS' VILLAGE is „OWNER DATE!OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. I i r Application to eP OPE.N`'09 E� Old Kings Highway.Regional Historic District Committee in the Town of Barnstable for a CERTI FICATE OF APPROPRIATENESS Application is hereby made, id triplicate, for the issuance of a Certificate.of Appropriateness under Section 6 of Chapter 470, Acts and Resolves of Massachusetts, 1973, for proposed work as described below and on plans, drawings or photographs accompanying this application for: CHECK CATEGORIES THAT APPLY: 1. Exterior Building Construction: ❑ New Building ❑ Addition. jAAlteration Indicate type of building: ouse ❑ Garage ❑ Commercial ❑ Other �16 2. Exterior Painting: ❑ 3. Signs or Billboards: ❑ New sign ❑ Existing sign ❑ Repainting existing sign 4. Structure: ❑ Fence ❑ Wall ❑ Flagpole ❑ Other (Please read other side for explanation and requirements). TYPE OR PRINT LEGIBLY DATE 10 /1., If C ADDRESS OF PROPOSED WORK 3 5 UJ I Ikt4) Sf ASSESSORS MAP NO. OWNER -,_A 0, eS -Jkkyss..e �'�(a vie 1✓�-4� - sl ASSESSORS LOT NO. 03 < HOME ADDRESS 7<-3 LV I I(b(4) 6a tran4tZ4TEL. NO. 5 d `s _56 z ? 1 0R FULL NAMES AND ADDRESSES OF ABUTTING OWNERS. Include name of adjacent property owners across any public street or way. (Attach additional sheett�if necessary). AGENT OR CONTRACTOR TEL. NO. ADDRESS DETAILED DESCRIPTION OF PROPOSED WORK: Give all particulars of work to be done (see No. 8,other side), including materials to be used, if specifications do not accompany plans. In the case of signs, give locations of existing signs and proposed locations of new signs. (Attach additional sheet, if necessary). to �}ft2 -e D o j r �4ia � � /2 Z Ise �4�1 1'� u`( U) UIt �= Signed Owner-C n ractor-Agent Space below line for Committee use. eceived by,H1D.C� U� -- ! Date I J1 The Certifi to'ls hereby Date Ell � 1,Fnl� � 1 , 1• 1 Time LX� y. 7B�j'r o. ti>a:ay Approved ❑ IMPORTANT: If Certificate is approved, approval is subject to the 10 day appeal period provided in the Act. Disapproved ❑ I Abuttors to: 353 Willow St. West Barnstable, MA 02668 Harold C. Weeks 240 Willow St. West Barnstable, MA 02668 Mel & Prudence Howes-Joseph 265 Willow St. West Barnstable, MA 02668 0. Edward Cantor 44 Gemini Dr. West Barnstable, MA 02668 Ms. Mary B. Cary 325 Willow St. ' West Barnstable, MA 02668 Barry G. Curtis 36 Tuckerneck Rd. Centerville, MA 02632 AUG �� :� . r Form "A-1" OLD KING'S HIGHWAY HISTORIC DISTRICT - S p e c S he e t Foundation Type Siding Type Chimney Type Color Roof Material Color - Pitch Windows Size Trim Color Doors Color ' > Shutters Gutters Deck Garage Doors Color Notes: Fill out completely, including measurements and materials/colors to be used. Three copies of this form are required for submittal of an application, along with three copies each of the plot plan; landscape plan and elevation plans, when applicable. *Plot plan need not be "Certified", but should show all structures on the lot to scale. L D.. H . Found 46 b _ � (10 14 n.. t�N _ tS� ... . ccl N � N Gs,ogG y5; 8 . So' 3 � , �t t' add;u r`' V ��f ��► �R I- ,�-+ �- - � t � � . � .; .• .`.� .�. t � _, ,,.,. - .� �. � �FtME tq� -I/j• The Town of Barn to le s b ,0�' Department of Health Safety and Environmental Services Building Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissioner For office use only Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL,c. 142A requires that the "reconstruction, alterations, renovation, repair, modernization, conversion, improvement, removal, demolition, or construction of an addition to any pre-existing owner occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors, with certain exceptions,along with other requirements. Type of Work: - Est.Cost 4/ Address of Work: .35 m l ll6-74) S�- IQ), Owner's Name ,, C&,"A Q`605 Date of Permit Application: id16 I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job under$1,000. Building not owner-occupied Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: d v. 2-0 x— 102 /C/ 9 Date Co ractor Name Registration No. OR Date Owne 's Na e The Connizonweulth of Massackusetty •�i� =_°.=�::r Department pf Industrial Accidents t Y I 1 " ollic. f117Y. ftztions `_ •�:w - -t\ 6O0 If'oslii►rrtun Street :..i Bovo►r, A1us:s. 02111 ' Workers' Compensation Insurance Affidavit �01ic tnt Information• Please PRIIVT'legy , namt location. city f3Q,rv� 5 1� nhoneit a /(09 ri 1 am a homeowner performing all work myself. r7 I am a sole proprietor and have no one working in any capacity _ 1 ...•S:•'r•.w•5.�.�..r�_...�.rAs�.'IAwitlG7�!�pl.". .. - _ ` •►�}�!^!�.�►_���..�,�..��e I am an employer providing workers' compensation for my employees working on this job. cmm�•tm n•tmc• address• city• Phone f!• insuran -e co. licy fl I am a sole proprietor. general contractor, or omeown circle one) and have hired the contractors listed below wh07 the following workers' compensation polices: compnoy name, U�' •tddrets• Cfi/�!�'�•G� S'! cirv- �, 7et�vn ram. �� nhonC t!• �GZ ��7� insurance co. nniicv a 002-0 '. .. .^ t'r .��P._ .."Z"�". _ _ _ ___ rTIV��.14'ST"� S. - - _•Tr t - C - - i_.L� cmmnnnv n•tmc• addre5T- city phone M• - insurance co policy it Attach additional sheet ifneees_s ,,:.: *•.:_o--,�;';-•s«•f�." :;L.:: ::" Failure to secure coverage as required under Section 25A of h1GL 152 can lead to the imposition of criminal penalties of a fine UP to SI-500.00 andiL one •cars' imprisonment as well as civil penalties in the form of a STOP NvORK ORDER and a fine of 5100.00 a day against me. 1 understand that cope of this statentcttt may be funvarded to the Office of Investigations of the D1A for coverage verification. I do herehr cerri •under-Nre pains and pens ies of perjure•that the information prodded above is true and correct. Si_nature Date //` Z2 �- I(Q Print name t;S '� Phone# �0Mci2l use univ do not write in this area to be completed by city or town ofriciai city or town• permitilicense k riGuilding Department ' Licensing Huard check if immediate response is required OScicetmen's Office ' C:3Ile2ith Department contact person: phone#; riOther �. Information and Instructions Massachusetts General Liws chapter 152 section 25 requires all employers to provide workers' compensation ford emplrn ees. As quoted from the -law-. an empluree is defined as every person in the service of another under any contract of hire, express or implied. oral or written. An rmplurer is defined as an individual. partnership. association. corporation or other legal entity, or any two or m, the foregoing enLa�sed in a joint enterprise, and including the le=al representatives of a deceased employer, or the receiver or trustee of an individual , partnership, association or other legal entity, employing employees. However owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwellino house of another who employs persons to do maintenance , construction or repair work on such dwelling_ 1 or on the rounds or building appurtenant thereto shall not because of such employment be deemed to be an emplo, MGL chapter 152 sca-ion 25 also states that every state or local licensing agenc}'sl►all 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. 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 chapte. been presented to die contracting authority. Applicants Please fill in the workers' compensation affidavit completely, by checking the box that applies to ;your situation an supplying company names. address and phone numbers as all affidavits may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sibn 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 reoui: to obtain a workers' compensation policy, please call the Department at the number listed below. ..•..: �w:I.M_ ./. r.r.. ..- ...rt.. .-.w n.. .lwr. �,'_ .+ S..r ... ..�1y. - •..V� �"... • • .•, City or ,towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottotr the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. F be sure to fill in the permit/license number which will be used as a reference number. 71te affidavits may be returne the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any quest:' please do not liesitate to `lye 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 fax #: (617) 727-7749 • TOWN OF BARNSTABLE .BUILDING DEPARTMENT HOMEOWNER LICENSE EXEMPTION Please print. DATE ZS- Qj(� JOB LOCATION �� Number Street address Section of town — "HOMEOWNER" x Name Home phone Work phone . - PRESENT MAILING ADDRESS &4_71C__ City town State Zip code The current exemption for "homeowners" was extended to include owner-occupied dwellings of six units or less and to allow such homeowners to engage an in- dividual for hire who does not possess a license, provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER: Persons) who owns a parcel of land on which he/she resides or intends to re- side, on which there is, or is intended to be, a one or two family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner" shall submit to the Building Official on a form acQaptAble 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 Stat Building Code -and other applicable codes, by-laws, rules and regulations. The undersigned "homeowner" certifies that he/she understands ...the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. HOMEOWNER'S SIGNATURE APPROVAL OF BUILDING OFFICIAL Note: Three family dwellings 35, 000 cubic feet, or larger, will be required to comply with State Building Code Section 127. 0, Construction Control. .may' HOME OWNER'S EXEMPTION The code state that: "Any Home Owner performing work for which a building Permit is required shall be exempt from the provisions of this section (Section 109. 1. 1 - Licensing of Construction Supervisors) ; provided that if Home Owner engages a person(s) for hire to do such work, that such Home Owner shall act as supervisor. " Many Home Owners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix 0, Rules and Regulations for licensing Construction' Supervisors, Section 2. 15) . This lack 'of awarenes often results in serious problems, particularly when the Home Owner hires unlicensed persons. In this case our Board cannot proceed against the inlicensed person as it would with licensed, Supervisor. The Home 'Owner. actin as supervisor is ultimately responsible. To ensure that the Home Owner is fully aware of his/her responsibilities, man communities require, as part of the permit application, that the Home Owner certify that he/she understands the responsibilities of 'a supervisor. On the last page of this issue is a form currently used by several towns. You may care to amend and adopt such a form/certification for use in your community. ssessoys map and lot number .......,s.....................•...... ..... *THEro lSewage Permit number '.:`:. u` ��Cl��f y ........... AHH9TABLE, House number" .5...................................' ............. vo i ....... MAB6 0 YPY a TOWN ' OFF BARNSTABLE BUILDING INSPECTOR ................................................................. APPLICATION FOR PERMIT TO'....�`.'`.`.. ..."`.......... TYPE OF CONSTRUCTION. ............ ... .n.. cX.... � .Wl •.,................................................................. ....... . ............ .......19.. . TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the followingp �informationr: Location .... .. ..)..............� �..t..�.�.O,ccJ „� W ....... ....................................:..................................................................... Proposed Use .......... c�.�C. .9� �r....................................................................................................................................... j P � ..................Fire District ...........' ! � ° >Zoning District ................ ....?................................ �.�1.,,.....:. Name of Owner )A .P.......1\�....,rPltcp��.....................Address ..... .. �..... 5 � wtl( W Nameof Builder ..... _. ..........................................Address .................................................................................... Nameof Architect .....0 u1.✓l .`r.......................................Address ............:............. ......................................................... Number of Rooms ..................................................................Foundation ...P1Q.��.-.K.......M!:5:.0 11:.—.q.......................... Exterior .......... ....e:�L .................................:.....................Roofin ....\��.5 .�.fi..S..................g .......... ........................... Floors ............................... ......................................................Interior .................................................................................... Heating ..................................................................................Plumbing .................................................................................. Fireplace ..Approximate. Cost .. .C��7...... Definitive Plan Approved by Planning Board -----------_______-----------19_______ . Area .... ..1... .. :. ,!..,. Diagram of Lot and Building with Dimensions Fee ........................................ SUBJECT TO APPROVAL OF BOARD OF HEALTH P •l T' ` r I OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable-regarding the above construction. '' Name .... �. .: v .�.. .. �.�:. %?-4..`........................... Construction Supervisor's License .................................... JENSES, JAMES N. & DIANE PHILOS A=131-32 2 No ....62......56.. Permit for QR.ar.a.ge.. A ........Ac.cje!ss.qry...j�9...PN.Q.,Uiag................ Location ....�51AUIQW..S.t;xp-e.t................ .................... ....RA-riastab.le........................ Owner ..Jejme ...N,....j ...... Philos Type of Construction' ....9,VaZ.P..............T.......... ................................................................................ Plot ............................ Lot ................................ Permit Granted .... 5..................19 84 Date of Inspection ....................................19 Date Completed ......................................19 Assessor's•map.and lot number ................. ...:...... ........ .... oFtNEr • Sewage Permit number .......... re ,. •w . `.� _ Z BAHBn3eTa { House number ......;3- ...�...............................................:.:... 9� iAO 00 �9 0 YPY d' TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO .... .v``.l."\................q...V:t ..::............................................................ TYPE OF CONSTRUCTION ................... )..O.©. ................................................................... ......... ..aY........ ......19... ..1 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following � information: Location .... .rJ^.3...............V .L. . . .!v.............. ............ ........................:...!��1.`..............�.�.`....!'........................................ ................................................................................................................... Proposed Use ..........��'.�a:�.:�.-. ................... Zoning District ............. ..�..................................................Fire District ...........1t1)...:..:..... Y. ..:....................................... 9(Cuv'.e. Vkt los Name of Owner .y�4..icA.e.5..... .-4.AS:e.'A ...................Address ....... ..}.....w.dk&ko........w........ Y\.r..... Nameof Builder ..... .W..t!t2.`. ............................................Address .................................................................................... Nameof Architect .....Q.W.;r A... .......................................Address .................................................................................... Number of Rooms Foundation ....................... Exterior ..........ems.. cXo, C_'......................................................Roofing ..........:1...1.. .:�U`!.Jk.S............................................ Floors ......................................................................................Interior .................................................................................... Heating ..................................................................................Plumbing .................................................................................. Fireplace ..................................................................................Approximate. Cost ........7.6...022 / Definitive Plan Approved by Planning Board -----------_-------------------19________. Area .... ..� . y ,A4 Diagram of Lot and Building with Dimensions Fee ' C ........�... �......... SUBJECT TO APPROVAL OF BOARD OF HEALTH OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. ! Name .... ........ .......................... ., Construction Supervisor's License .................................... J ,ilSES, JAME'S 'N. E 'DIA E PHILOS r� 26256 B ild Garage;, No ................. Permit for . .. . .................... sory....to-..DWe.1d ing................. Location 353, Willow S.t;r;ept................. W. Barns,tall. ............................ ............. ........ Owner ...James N. Jenses & pi,,AT,e„ P 1i1os Type of Construction ...... Vie....................... ................................................................................ Plot ............................ Lot ................ ........... Pei'mit Granted ....April 5, 1984 Date of Inspection ....................................19 Date Completed ....:......... r............19 AVassotfice (1st floor): /� 3-2— � ME Assessor's map and lot number .. ........./............... ... .... .�E�� Board of Health (3rd floor): Sewage Permit number . ...V...g�..�Ta. ..... .. �r AWSTSDLE. i Engineering Department (3rd floor): .� � � House number ........................... .... .. . aY Definitive Plan Approved by Planning Board ________________________________19________ . APPLICATIONS PROCESSED 8:30-9:30 A.M. and 1:00.2:00 P.M. only. TOWN OF BARNSTABLE BUILDING I SPECTOR APPLICATION FOR PERMIT TO .................j. . ..t� ..�f�. .................................................................................... TYPE OF CONSTRUCTION .............•. Y t7. . .......... .... ..A............................................................ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit acc 7 ding to the f flowing informat'on: Location ..:.Y��J.. / .�. �� {'VC�r�. :..:.... ................. . . /� r r , Proposed Use ..........,�.J.,rf. (.t. a. ..:......... . ... ............ .. . ...�rQ... Zoning District .................................. .:.......................Fire District "l d.le!9 ..... Name of Owner . .:. ..:........ /. e..: �s4� ,.Address 7: Name of Builder JG QG . . Address ...:.. �.. �..... ,� , ....zlo, :...,r .... sabx�" Name of Architect ............... ................................Address ....................... ..... 77777............................................. Number of Rooms :.... .... �� .... ..... .... ..............Foundation ...... . Exterior ...... ......G.�� Off'~... ..... GLF'. .b�ofing .....' V,3. ....... .... .. ..... �. .....�s.E'.�.. .. ,. Floors ........�.. �y7,..............................................................Interior .....y ae. D^� - -. Heating ...... ...... Sri.... G�'. . ................Plumbing �v�.....'.`' Fireplace ..............., D.......................................................Approximate Cost .............. ..0.... ......... .. Area Diagram of Lot and Building with Dimensions Fee P OL OCCUPANCY PERMITS REOUIRED—FOR NEW—DWEM-NGS 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 ...016, ........ JERSEY, JIM & DIANE No ... Permit for ...Build...Addition ......Siaq.�...T�ppi ly...P!��f�ing ..... ..... ...... ......... Location ...3.5.3....W.i 1.1 o.w....S.t.re.e.t.................. .. . .. .... .... .. West Barnstable fr Owner .... Jersey .............. .J...i.m......&.....D...i.a..n....e.....J.... Type of Construction ....Frame......................... . ......... .............. ......... ............................................. Plot ............................ Lot ................................ Permit Granted ......February 7.......19 89 ...........:.............. .. Date of Inspection ..... ..... .....................1-9 Date Completed .......... .................19 Assessor. ffice (lst4."floor): �. /J �THE T Assessor's map and lot number .. ...... o� �............ e�Q^ ��♦� Board of Health (3rd floor): Sewage Permit number OO ((�� (Jr .................. . . Engineering Department (3rd floor): +°o t69 3 • House number ................................. .............3.. ....3..... 7'( '�e�Ar d• Definitive Plan Approved by Planning Board ________________________________19-------- . APPLICATIONS PROCESSED 8:30-9:30 A.M. and- 1:00-2:00 P.M. only TOWN OF BARNSTABLE BUILDING INSPECTOR - �� � APPLICATION FOR PERMIT TO ..................��'..�?N. .l.•�„fL. ..�................................................:................................ I TYPE OF CONSTRUCTION .............. f.. D.............. ...... ........ ��..r............................................................ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit acco ding to the f Ilowing information: YP'r.> yri. S" ................ .....................' ..� s� e Location ............. , . .......%/E11 .� ....G................ Proposed Use ..........:....l.l'r . .€q..... 5...:........ ..............14�...... ;t7c3 .. - �a �. �. . .......... ..... Zoning District .................................. .. ......................Fire District f �SC� 7 ......... ......................... Name of Owner ... .. �k'1.,. .........��,/ �✓lr'.... 5'E' Address s:.. /........ n.? f�... 5.......rf . Name of Builder .......� /.�.��.. .r..... .....�l..� ... ���. Address Name of Architect -r- ................................Address.... .................... ............................................................... Number of Rooms ..... .....T .111!-�,.sP.....K.3... ..........Foundation .......1�51.......................................... ...................... Exterior ....... f ,...( ....... ��. ../x: �. .. �GY!t../?.c—, oofing ....../.Y..S��i.� ..... �... .... Floors /....,:.;?.. .............................................................Interior .......�t.. .....Sa..... !.C -................................. i:/..........v-.. �� Heating .......(..'.. t- ..0....-.....,....J�!t��'....:.�..r�................Plumbing ......... ............................................................ Fireplace ................ . ,.........................................................A roximote Cost � .. �.;....,.... .r Area Diagram of Lot and Building with Dimensions Fee ..................................... `-� ' �V OCCUPANCY PERMITS REOUIRED FOR NEW DWELLINGS tt I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. W Name .... .............................1....................................... Construction Supervisor's License .... 1 ........ JERSEY, JIM & DIANE A=131-032* i31-030R No ..326.2.8... Permit for ....Build Addition ................................ ing ..... Single. ... ..... ..... Location 3.51.Ki1.10W...S.t.re.e.t................. .. .. .... .. .. Barnstable „West.......................................................... Owner ...Jim...&...D.i.an.e...Jersey............... .. ..... .. .. .. .... .. Type of Construction ...Frame.......................... ............................................................................... Plot ............................ Lot ................................ Permit Granted ........F.eb.r.uary...7......19 89 Date of'Inspection ....................................19 Date Completed ......................................19 Q P L.0 T PLAN A. F W, T B,�-7,9 _ r m sysr�� Dkr-E.U;, S E•PT. Z , . • -- � / '� off- - -- - - _ . : . / 5 0 R1/ E,.f€�� � O `E N M E E ` CGSF U,E D 43QQK .Z 1 PAGE Dn WE _ N _ i���f�'f�D~�/�. PPRO AL (�uT. R�n' D'' 5 1970 . Al 7 7— j'} +'�y.y.y^�.'`i-, _c.....r 7 t •�. fir..;-w.��3. _ _.. r!', qr. - C�J•.��.. _ let? WEST* BA k Ta-me,S. � �E!YSQ vt, Z C>V\-Q-A F �' Se-t- i3 a V\, �-o h r J 2�