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HomeMy WebLinkAbout0024 ATHLONE WAY del A-Fn lone Wes( J J oFmsTown Barnstable *Permit sRegulatory Services EFePs 6 mo»tlrs jronr issue date s ',: iARNSTABLS, 9cb 1 �0ma Richard V.Scali,Director Building Division Tom Perry,CBO,Building Commissioner[L_.v:2 9 e t,'m 200 lufain Street,Hyannis, IVtA 0260,1 l0�r�!� �' �HIiIVS if��L� www.town.barnstab le.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESEDENTIAL ONLY ;btap/parcel Number z f � c 21,q Not Valid without Red X-Press Imp►int I Property Address .7 AT)4 LL9A)F- LOH (Residential Value of Work S 74 k Minimum fee oft$35.00 for work under$6000.00 Owner's Name&Address DI 1 Q,I- Contractor's ALE (4),J1-3w�A //r spl( Telephone Number Home Improvement Contractor License#(if applicable) �73 t-( j Email: Construction Supervisor's License#(if applicable) O -5 707 C21workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ �m the Homeowner LLr I have Worker's Compensation Insurance Insurance Company Name F;c ame n Z-1 st®ra,-,r.e Workman's Comp-Policy# W c A �"$ 7 2,9 — 2 c� Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side 3 Replacement Windows/doors/sliders.0-Value (maximum.32)#of windows #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical& Fire Permits required. *Where required_ issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic.Conservation,etc. ***Note: Property _Owner must sign Property Owner Letter of Permission. :�copy the Home Improvement Contractors License&Construction Supervisors License is require SIGNATURE: C:\Users\Decollik\AppData\Local\Microsoft\Windows\Temporary lntemet Files\ConteRLOutlook\2P101 DHR\EXPRESS.doc Revised 040215 Renewal Agreement Document and Payment Terms Jill lder$en' dba:Renewal By Andersen of Southern New England Mary George M Legal Name:Southern New England Windows,LLC 24 Athlone Way RI#36079,MA#173245,CT#0634555,'Lead Firm#1237 : Hyannis,MA 02601 10 Reservoir Rd 1.Smlthfleld,.Rl 02917 - - H:5087781138 - - Phone:866-563-2235 1 Fax:401•-633-6602 1 sales®renewalsne.com . Buyer(s)Name: Mary George ' Contract Date: 12/09/17 24 Athlone Wa Buyer(s)Street Address: y, Hyannis, MA 02601 . Primary Telephone Number: 5087781138 Secondary.Telephone Number Primary Email: elisegeorge523@yahoo.com Secondary Email: - Buyer(s)hereby jointly and severally agrees to purchase the products arid/or services of Southern:New England Windows,LLC d/b/a Renewal By Andersen of Southern New England("Contractor"),in accordance with the terms and conditions described in this Agreement Document and Payment Terms,any documents listed in the Table of Contents,and any_other document attached to this Agreement Document,the terms of which are all agreed to by the parties and incorporated herein by reference(collectively,this"Agreement'). Buyer(s)hereby agrees to sign'a completion certificate after Contractor has completed.all work under.this Agreement. Total Job Amount: $7,682 By signing this Agreement,you acknowledge that.the Balance Due,and the Amount Financed must be made by personal check,bank check,credit card,or cash Deposit Received: . $0 Balance Due:. $7,682 . - Estimated Start: � Estimated Completion. - 8-10 weeks " 840 weeks Amount Financed: : $7;682 Method of Payment: Financing . We"schedule installations based on thedate of the signed contract and secondarily on the date in which we complete the technical measurements.The installation date that we:aze providing ai this time is only an estimate.We will"communicate an official date and.time at a later date.:Rain and extreme weather are the most common causes for delay.. Notes: 50% DEP 50% ON COMPLETION TAXES PD HYANNIS MA Buyer(s)agrees and understands that this,Agreement constitutes the entire understandings between the parties and that there are no verbal . understandings changing or modifying any of the:terms of this Agreement.No alterations to or deviations from this Agreement will.be valid without the signed,written consent of both the Buyer(s).and Contractor.Buyer(s)'hereby acknowledges that Buyer(s). 1)has;read this Agreement, understands the terms of this Agreement,and has received a completed,signed,and dated copy of this Agreement,including .: the two attached Notices.of Cancellation,on the date first writteti above and 2)was orally informed of Buyer's right to cancel this Agreement. NOTICE TO BUYER: Do,not sign this contract if blank.You are entitled to a copy of the contract at the time you sign. YOU,THE BUYER, MAY CANCEL THIS TRANSACTION AT ANY TIME NOT.LATER THAN MIDNIGHT. OF 12/13/2017 OR THE THIRD BUSINESSDAY AFTER THE DATE OF THIS TRANSACTION, WHICHEVER DATE IS LATER:SEETHE ATTACHED NOTICE OF CANCELLATION FORM FOR AN EXPLANATION OF THIS RIGHT. Legal Name:Southern New England Windows,LLC dba:Renewal By Anders i�of Southern NewIngland Buyer(s), lV Signature of Sales Person' Signature. Signature i Eric Woods Mary George Print Name of Sales Person Print Name Print Name. UPDATED: 12/09/17 Page'2 / 10 .. Massachusetts Department of Public Safety IF Board of Building Regulations and Standards License: CS-095707 Construction Supervisor BRIAN D DENNISON 7 LAMBS POND CIRCLEFVQ Na CHARLTON MA 01507� '` �-•^� lJ�� Expiration: Commissioner 09/08/2018 7 �_�, '`J$7.G FlJ�1/�?'tit?2 f/77il,Cl('i(,i�7�tiA't� �✓n�l'f.�.^e/�2%(./!'!/I.G.11? Office of Consumer Affairs nd Business Regulation .. 10 Park Plaza-Suite 5170 Boston,Massachusetts 02116 Home ImprovemiepttContractor Registration _ IE� RepisVation: 173245 Type: Supplement Card Expiration: 9/19/2018 SOUTHERN NEW'ENGLAND WINDOWS�LL-,,jg�:—f,i.' BRIAN DENNISONr-' 26 ALBION RD =_y� ra=== LINCOLN,RI 02865 r=' L update Address and return card Marl:reason for change. scA; C MM-Wn ❑Address Ci Reuewal ,Employment Ci:Lost Card Offim of Consumer Affairs&Bwioer."Regulation Registration valid for individual use unty before the #OME-IMPROVEMENT CONTRACTOR expiration date.If found return to: Office of Consumer Affairs and Business Regulation Re xpiratlon_y73pg5_ Type: 10.Park Plaza-Suite 5170 EXPiro!!=f!/19T207 ti Supplement Card Boston.MA 02116 it- _ SOUTHERN NEW ENGZ6;'WINDOWS LLC. RENEWAL BY ANDERS_ON- =.=' BRIAN DENNISON 26 ALBION RD n LINCOLN,RI 02865 , d.- rsecreinry Not valid without signature ` The Commonwealth of Massach usetts .t Department of Industrial Accidents I Congress Street, Suite 100 Boston,MA 02114-201 i www,mass.gov/dia Workers'Compensation Insurance Affidavit:)Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERIVIITWgG AUMORITY. Applicant Information Please Print Le 'blr- /vane (Business!Orgardzuionlndividual): C Address: City-/State/Zip: P Phone is kj - 2�g Are you an employer?Check the appropriate box: Type of project(required): 1_X]am a emplgver writh ZO tempioyees(full and/or par-time).' ?_ Ej l`ew construction 2.❑I am a sole proprietor or partnership and have no employees working for me ir. S. Remodeling any capacin.Teworker<'comp.insurance required-1 - 9. ❑Demolition 1 I am a homeowner doing at!wo.*k myse;f?:e workers-comp.insurance required. 10 E]Building addition ..❑1 am a homeowner and wil be hiring contractors to conduct all work or:my property. I wiL'• easure that all contractors either have workers'compensation insurance or are sole I I I-[:]Electrical repairs Or additions proprietors witL nc employees. 12.Q Plumbing repairs or additions ` 1 am a general coat mcto-and 1 have hired the sub-contractors listed or:the attached sheet. 1 1= These sub-contractors have employees and have worker_'comp.insurance . Roof repairs E.❑We are a corporation and it--officer:have exercised their right of exemption.per MGL c. 14.�50tber�/�/ 15 2 E I(4),and we have ne employee. q workers'comp.insumrce requirea._ I i t .Any applicant that checks box I,?must also fill out the section below showing their workers'compersatior policy inf0rmatior,. Homeowners who submit this affidavit indicating they are doing all wort:and then hire outside contactors must submit a new affidavit indicatin€such. lContr actors that check this box must attached at:additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. Lithe 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 polio•and job site information. Insurance Company Name: `ire ine SP s. 60m — Policv#or Self-ins.Lic. A v 1-5 8`12-q — 2-0— Expiration Date: / f Ll O G,9��� V City/State(Zi "141(_S /rt Job Site Address: P Attach a cope of the workers' compensation policy dec ration page(sbowing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152. F25A is a criminal violation punishable by a fine up to S1,500.00 and/or one-year imprisonment as well as civil penalties;in the form of a STOP WORK ORDER and a file of up to S250.00 a day against the violator.A copy ofthis statement may be forwarded to the Office oflnvestigations of the DIA for insurance coverage verification. 1 do hereby certify under ihe, ai?s andpenalties ofperjun that the information provided above is true a d correct Si ature: a Date: /Z 2 /7 Phone 0: Official use only. Do not write in this area.to be completed bt,city or town official ` Citv or Town: Permit/License# 4. Issuing Authority.(circle one): 1.Board of wealth 2.Building Department 3.City,'Town Clerk 4.Electrical Inspector 5_Plumbing Inspector 6.Other Contact Person: Phone l.i: ESLERCO-01 SANDERSO ,acoRo CERTIFICATE OF LIABILITY INSURANCE DATE 0610712017Y' os+o7i2o17 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE.OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. , If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). CONTACT PRODUCER NAME COBiz Insurance,Inc.-CO PHONE 303 988-0446 FAX No):(303}988-0804 1401 Lawrence St,Ste.1200 (wc,Nc,6d):( ) Denver,CO 80202 E-MAIL IEESS,COMaiI cobizinsurance.com INSURERS AFFORDING COVERAGE I NAIC Y INSURER A:Acadia Insurance Company 31325 INSURED INSURER B:Firemens Insurance Company of WA D.C. 21784 Southern New England Windows,LLC.dba Renewal by INSURER C:Liberty Surplus Insurance 110725 Andersen of Southern New England 26 Albion Road,Suite 1 INSURER D: Lincoln,RI 02865 INSURER E: j INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD i j INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR I ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS TR TYPE INSURANCE I OF INSURA INSD WVD MMIDD MM/DD A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE is 1,Op0,000 CLAIMS-MADE X OCCUR CPA3158728 01/01/2017 01/01/2018 DAMAGE TO 300,0001 � I I PREMI ES Ez occurrence) 5,000I j I MED EXF(Any oneperson) j - 1'000'OOO PERSONAL S ADV INJURY I S 2,000,0001 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE 'i X i POLICY L�PRO- CI LOC i I PRODUCTS-COMP/OF AGG .•: 2,ODO,0001 JECT i EBL AGGREGATE i 2.000,0001 I OTHER: S 1,000,OD0j COMBINED SINGLE LIMIT i A i AUTOMOBILE LIABILITY Ea accident � T ANY AUTO CPA3158728 i 01/01/2017 01/01/2018 BODILY INJURY Per erson •S 1 ~I OWNED SCHEDULED I I S I �J AUTOS ONLY AUTOS - BODILY INJURY Per accident HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY I Per accident I I 5 A X UMBRELLA LIAR X OCCUR 1,000,000 EACH OCCURRENCE I EXCESS LIAR CLAIMS-MADE CPA3158728 01/0112017 01/01/2018 AGGREGATE 0 Aggregate I S 1,000,000I DED X RETENTION S _ $ WORKERS COMPENSATION X STATUTE ERH j AND EMPLOYERS'LIABILITY YIN WCA3158729-20 01101/2017 01/01/2018 1,000,OOOj ANY PROPRIETORlPARTNERIEXECUTIVE i E.L EA ACCIDENT S OFFICER/MEMBER EXCLUDED? I NIA i 1,000,OOOI (Mantlatory in NH) �' E.L.DISEASE-EA EMPLOYE 5 It yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ Worker's Compensatio WCA3158730-20 01/01/2017 01/0112018 1,000,000 117 01/01/2017 01/01/2018 11000,0001 I I DESCRIPTION Workers OFF OPERATIONS I LOCATIONS Includes-I VEHICLES Al States(ACORD except, OH,Additional Rema�s�ule,may be attached if more space is Tequired) I I I I CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. IAUTHORIZED REPRESENTATIVE F R InformatignalPr ©1988-2015 ACORD CORPORATION- All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD �1 r -Town of Barnstable *Permitcb 1 Tres 6 t u Regulatory Services Fee n rh u e e BMWSTABLS, 9� crass Richard V.Scali,Interim Director ArED MP't� Building Division . Tom Perry,CBO,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESSTERMIT APPLICATION - RESIDENTIAL ONLY n �� Not Valid without Red X-Press Imprint Map/parcel Number 'lam 1 r•Property Address ®Re t-4 w 4 i esidential Value of Work$ ��� Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address Q c 2 Contractor's Name_j Telephone Number Home Improvement Contractor License#(if applicable)�!�3 l,� Email: 7Worlanan's ion Supervisor's License#(if applicable) 5Z74 f�P " it Compensation Insurance Check one: ❑ I am a sole proprietor OR 2 8 2014 ❑ Imf the Homeowner have Worker's Compensation Insurance 1 - 7�O�Jfl9®� A� `T��L Insurance Company Name � p E Workman's Comp.Policy#_� 1.✓ l{-7 (/ O 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 ❑ e-roof(hurricane nailed)(no�stripping. Going over existing layers of roof) Re-side '� ❑ Replacement Windows/doors/sMders.U-Value (maximum.35)#of windows #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is required. SIGNATURE: Q:\WPF ORMS\building permit forms\EXPRESS.doc R ised 061313 Client#:33723 ' CAREF ACORD- CERTIFICATE OF LIABILITY INSURANCE F DATE THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(les)must be endorsed.If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s), PRODUCER CONTACT Herlihy Insurance Group Inc. NAME:PHONE FAX A/c No Ell:508 756.5159 Alc,No): 508-751-5747 51 Pullman Street L Worcester,MA 01606 ADDRESS: 508 756-5159 CUSTOMER ID#: INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURERA:Peerless Ins.Clomp.Car - 239 Free Homes INSURER B:EastGuard Insurance Company. Fairhaven, M n A 02719 Hut Ave 3 INSURER C:Safety Indemnity Insurance Comp .. Fai M �' r INSURER D: INSURER E INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. I SR I TYPE OF INSURANCE BR POLICY EFF POLIC EXP LTRINSR D POLICY NUMBER MM/DD/YYYYl (MMfDDIYYM LIMITS A GENERAL LIABILITY ` CBP6929704 09/01/2013 09101/2014 EACH OCCURRENCE $1 000000 X COMMERCIAL GENERAL LIABILITY -DAAGE ORE D PREMISES Ea occurrence $100,000 CLAIMS-MADE Ex�OCCUR * MED EXP(Any one person) $15,000 X BUM Ded:250 , PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000 POLICYFI PRO- LOC $ C AUTOMOBILE LIABILITY 6213850` 07/01/2013 0710112014 COMBINED SINGLE LIMIT id E( a accent) $1,000,000 ANY AUTO BODILY INJURY(Per person) $ ALL OWNED AUTOS " X SCHEDULED AUTOS BODILY INJURY(Per accident) $ PROPERTY DAMAGE $ X HIRED AUTOS (Per accident) X NON-OWNED AUTOS $ $ UMBRELLA LIAB OCCUR " - p EACH OCCURRENCE $ EXCESS LIAB HCLAIMS-MADE AGGREGATE $ DEDUCTIBLE c $ RETENTION $ B WORKERS COMPENSATION AND EMPLOYERS'LIABILITY CAWC471104 09/01/2013 09/01/201 X WC STATU- OTH- ANY PROPRIETOR/PARTNERIEXECUTIVE `` ` YIN, E.L.EACH ACCIDENT ER $100,000 OFFICERIMEMBER EXCLUDED? NIA (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $100,000 If yes,describe under DESCRIPTION OF OPERATIONS below " E.L:DISEASE-POLICY LIMIT $5OO OOO DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) CERTIFICATE HOLDER CANCELLATION 10 Days for Non-Payment SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Town of Wrentham y, ACCORDANCE WITH THE POLICY PROVISIONS. 350 Taunton Street , Wrentham,MA 02093-1383 AUTHORIZED REPRESENTATIVE 048-8-2069-A4011D CORPORATION.All rights reserved. ACORD 25(2009/09) 1 of 1 The ACORD name and logo are registered marks of ACORD #S63800/M63712 AAG .2 to Co2nmararueakh gfMassachustzs Depurt>nmt of to ter &id Accidents -- f3,�ire v,f i�m�str�afio�rs. 600 KThingtoM&reet Bostait ,MA 02LIJ wranv.mass.gosv!dia Workea-s' Compensation Insmmnce Affidavit:B.-ilders/Coia ractorsMectricianslPlumbers AP.Pficant Infisrmation Please PrintLeg-ill Name gwsineaslO�gamz&on/!n&idna0: fj 11W Address: -7--� kl-j W I 44e, City/statrjz*. O3 7-71 9 Phone 4 Are you an employer? Check the appropriate box: T • of oect (r Yl� l�' � ���ff)= eneralcontractor and 1 6- New boa I_�am a employer witfL 20 4. I am a. employees{full andlorpart-t me}* have hired the sub-cone aclors 2-❑ I am a sole proprietor orpartner Usted on the attached sheet; 7- [ odeling 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'caOnp_intu mnre Comp-inMWAUM Wired-] 5. We are a co>poratica and its 10..0 Electrical repairs or additions 3_❑ 1 am a homeowner doing all work officers have exercised their 14_.❑Plumbing repairs or additions myself[No,Norte'comp- right of exmption per MGL 121-1 Roof repairs insurance regnirecl]1 c-152,§1(4),and we hmm no employees-[No Workers' 13_❑other comp-insurance required:] *Any appticont d at charts boa 91 mast also fill out the section below showing ages waiters'compenwiaa poaT iofamn Tao- t Snmeo wners who submit this aTiid:vit irfcstnrg they ere doing all wcA sad then hire outside contractors most sahmit a new affidnit iotiaretmg m rh_ 1Cbniracmrs that cfieck this boat must attached=additional sheet awwiag the mane of de smh-oof mctoa and state vrhether mcnot these odities hm e employees Ifthe sub-conttaam hire employees,they must provide their workers'comp.policy number- lam an empZayer thatrsprmidiag ivorkers'cotttpwmition insnrrazce for my employea& Beiaty is SIB pp7icy and job site infntmatiart. Insurance CompanyNatne: Palicp;or Self-ins.Lic- /(� Expiration Date: Q/ Job Site Address. Cityf5tat&2Zp: N Aftach a copy of the workers'compensation policy - ration page(showing the policy number and expiration date). Failure to secure coverage as requireduncler.Sectioh A of MGL r 152 can lead to the imposition of criminal penalties of a fine up to$1,50000 andlar oneyearimprisotment,as well as civil penalties in the fim of a STOP WORK ORDERand a fine ofup.to$250-0.0 a day against the violator. Be advised that a copy of this staten=tt may be forwarded to the Office of Investigations of IA for insurance cov croon I do It cc rnarder t 'tts al as un'thatthe zrrformatcorn provided above is.trlre d co ct Bate: Phone#: iWE al use only. Do not tvAbr in dais area,tia be completed by city or town officiaL. City or Town: Permi#1License if Issuing Authority(drcle one): 1.Board of$eaI`th 2.Buff-ding Department 3.Cityfrown Clerk 4.Electrical Inspector S.P1umbh3g inspector 6.Other f ■■ FOR it ARE FREE 01 leS Inc. 239 Huttleston Avenue Fairhaven,Mass 02719 Telephone 508-997-1111 Fax 508-997-1297. Website: www.carefreehomescompany.com To the Town of. /7"l"h 5 Job Address: GG � owner of the home Customer Name at the above location, authorize Care Free Homes,Inc. as my agent to obtain all necessary permits and to perform all home improvements to my home as stated in the accompanying contract and application. JCusto er Signature ate w. Massachusetts -Department of Public Safety Board of Building.Regulations and Standards Construction Supervisor. . License: CS-095228 s. DANA J PICKUP . 239 Huttleston Av# Fairhaven MA OT719 .) o% Expiration r Commissioner 03/22/2016 . �ZP (QOi/77A720�IZLU L O LZddllC ZLGdG'�.d - ff c s C nifier riff es&Tsusmess Regulation 'ME lM11PROVENILNT-CONTRACT6R egistrapgp -ibb5b3n, Type Expiratson 6 19�" /2b1a „ SUp4? lement CARE FREE HOMES rNC 4F r DANA PICKUP JR 1 , ave. i -Hut 239 tleston rai;i4aven �JLA 0271.9. Undersecretary `r I , et Massachusetts -Department of Public Saf y Board of Building.Regulations and Standards Construction Supervisor y License: CS-095228 DANA J PICKUP 239 Huttleston Avg Fairhaven MA 0119 I n ?� ExP ieation 0 commissioner I Comma 3/22/2016 License or;reg stration valid for Sri"cv►dul use onI 'pefore the exp ration dater If&U,nd reuirn to j. i Office of Consumer Affairs artd Business regulation �l0 ParkPlazi Suitc 51.70' r :P, N �ston, >A02Ff6 .. '.:,., • Not valid without sag re r PI CAPE COD ( INSULATION FIBER OLASS SEAMLESS SPRAY FOAM .SUSPENDED BATTS OUTTERS INSULATION CEILINGS 1 800-696-6611 � ' f Town of Barnstable Regulatory Services Building Division 200 Main St Hyannis, MA 02601 Date: ,/�j �0- Dear Building Inspector Please accept this Affidavit as documentation that Cape Cod Insulation, Inc. performed& completed the insulation and weatherization work at the property listed below. Cape Cod Insulation did this in accordance to the specifications listed on the building permit application. All work has been inspected by a certified Building Performance Institute (BPI) inspector. All work preformed meets or exceeds Federal & State Requirements. Property Owner. Property Address Village Insulation Installed: Fiberglass Cellulose R-Value Restricted Unrestricted' 3 Ceilings Slopes )•. ( ) (, ) ( ) ( ) Floors ( ) ( ) ( ) ( ) ( ) nWalls ( ) ( ) ( ) ( ) ( ) Sincerely n H y C ssid Jr, President Cdpe Cod/insulation, Inc. TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION e of 5A 4 0,qT Map Parcel �� A ication # T Health Division i' r? ttelsued Conservation Division ,Application Fee Planning Dept — Permit Fee ' D 1 V I S Date Definitive Plan Approved by Planning Board Historic - OKH Preservation / Hyannis Project Street Address �/" ✓!�r ZD N Z_ UZ26y Village 4441 bX Owner Y, f,e 6f6 2 f e Address Telephone;��l� / /►�A' Permit Request !Z�q I'd �m.4 M ZIrW L oA�ig 7-1W e 144a Je ! Square feet: 1.st floor: existing _proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation O O ,GConstruction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family 8**" Two Family ❑ Multi-Farnily(# units) Age of Existing Structure Historic House: ❑Yes ;Jr o On Old King's Highway: ❑Yes ,T<o Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing _ new Half: existing new Number of Bedrooms: existing —new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ,❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review # Current Use Proposed Use Y APPLICANT INFORMATION UILDER OR HOMEOWNER) Name �� G , Z .fv��¢� �y Telephone Number �`,724 Z 4' Address f"1� Y A A? Mp Li 14� � License # .Home Improvement Contractor# /d 4 Worker's Compensation #I�i/G'�d d J-Z ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE __DATE } FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED E. " MAP/PARCEL NO. `t ADDRESS - = '; VILLAGE OWNER DATE OF INSPECTION: r X FOUNDATION > FRAME l INSULATION FIREPLACE s, ELECTRICAL: ROUGH FINAL- PLUMBING: ROUGH FINAL > 0. y GAS: ROUGH -,,�— FINAL -FINAL BUILDING:'_ ;..3v s ' F DATE CLOSED OUT ASSOCIATION PLAN NO. f Wad 10 Park Plaza - Sui 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration . Registration: 153567 Type: Private Corporation t - Expiration: 12/15/2012 Tr# 2.06433 v CAPE COD INSULATION, INC HENRY CASSIDY 455 YARMOUTH RD. `n; t HYANNIS, MA 0260 �v t - Update Address and return card.Mark reason for change. Address Renewal Employment Lost Card DPS-CA1 it 50M-04/04-G101216 Office o mer Affairs us ne Re uI lion License or registration valid for irdi�•idu!use, e!; HOM 6Vt��SN tVA;Z before the expiration date. If found return to: Registration: 153567 Type: Office of Consumer Affairs and Business Regulation /1 /2 1 Private Corporation 10 Park Plaza-Suite 5170 Vio Expiration: 12 5 0 2 pBoston,MA 02116 D INSULATIO`N,'INC-: HENRY CASSIDY;'; _ate { 455 YARMOUTH RD`-�,4 HYANNIS, MA 026010 Undersecretary Atalid ith t si tune Mitss;tchusetts-Department of Public Slkfet% Board of Building Re«ulations and ton •S <t lords . Qonstruction Supervisor License License: CS 100988 tAs HENRY CASSIDY 8 SHED•ROW WE T`�ARMOUTH WA 02673 Expiration: 11/11/2013 ('uminiai ner Tr#: 7620. Client#:4597 CCINSUL A ©RD ,M CERTIFICATE OF. LIABILITY INSURANCE DATE(MMIDDIYYYY) 2/02/2012 THIS=SERTI#ICATE IS ISSUED AS A MATTER OF INFORMATION ONLY-AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT.CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.- : e ce I Ica e o er Is an a po Icy les musta en orse su lec o the terms and conditions of the policy, certain policies,may.require an endorsement.A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). , PRODUCER NUUN AME: MargaretYoungY Rogers&Gray Ins. -So. Dennis ;. PHONE FAX (ac No.EXt:508-760-4602 877-816 2156 434 Route 134 ETaAa -- -- -- - - -- -:-- -lac, No). ADDRESS:youngma.@rogersgray;com 'P.O.BOX 1601 '° PRODUCEK 'South Dennis,MA 02660-1601 CUSTOMER ID#: r '• INSURER(S)AFFORDING COVERAGE _ NAIC# INSURED ° INSURER A:Peerless Insurance ' 18333 Cape Cod Insulation Inc ; INSURER a:Ohio Casualty Insurance Company 455 Yarmouth Road r .., Hyannis, MA 02601 INSURERC:Atlantic Charter Insurance t INSURER D:Commerce Insurance Company 34754 ( ` INSURER tE 1. ` . "INSURER F: . I ` • ' } , COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW.HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF - SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS NSR ADDL SUBR POLICY EFF POLICY EXP in A GENERAL LIABILITY CBP8263063 94/01/2011 04/01/2012 EACH OCCURRENCE .. $1,000,000 - , DAMAGE TO RENTED X COMMERCIAL GENERAL LIABILITY � - ", ` PREMISES(Ea occ.uTen�e) $100,000 • w. ✓ CLAIMS-MADE X OCCUR - - - --.-.-..__.... .. °. - . '', � ''- `e � _MED F�(P(Any one pe,son). � $S,000 r. • +: _ PERSONAL&ADV INJURY' _ $1,000,000 y r GENERAL AGGREGATE $2,000,000 GEN'L.AGGREGATE LIMP!APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000 PRO- r. { $ D AUTOMOBILE LIABILITY • 11 MMBCKVMK - 04/0112011'. 04#0.1/2012 COMBINED SINGLE LIMIT $ , ANY AU I O - Y _ . (Ea accident) 1,000,000 .BODILY INJURY.(Per.putsun) At.[.OWNED AUTOS . -^- °. ; '. $ - r.� BODILY.INJURY(Peraccident) $ - X SCIIEDLILEDAUTOS �. •'� - )� .PROPERTY DAMAGE.- t X HIRED AUTUS r f ; .• , $'- (Per accident) X NON-OWNED AUTOS • - r:. a:. .. - ' $ -.e ,• -T. B UMBRELLA LIAB _X _OCCUR, UUO1254514645 .04/01/2011 04/01/2012 EACH OCCURRENCE' $1,000,000 ' EXCESS LIAR - V CLAIMS-MADE • AGGREGATE $1,000,000 _ AGGREGATE DEUUCTIHLE * X,HEIENIION $ 10000 ' • i t } C WORKERS COMPENSATION WCAOU5259O2 .U6I30�2O11 WC STATU- OTH- - AND EMPLOYERS'LIABILITY YIN - - 06/3OI2O12.X..TORY LIMITS . ER _ ANY PROPRIETOR/PAR TN ER/EXEC UTIVE _ E.L.EACH ACCIDENT - $500,000 OFFICERIMEMBER EXCLUDED? N NIA ` .. f: ,. (Mandatory in NH) It Yes,00SUIbe Under E.L,61SEAS.E;EA EMPLOYEE$500,000 E.L.DISEASE-POLICYLIMI )ESCRIPTION OF OPERATIONS%LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required), Norkers Comp Information Included Officers or Proprietors ,ERTIFICATE HOLDER CANCELLATION ' _. .. _ a , s SHOULD ANY OF THEABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF;NOTICE WILL BE DELIVERED IN ( 'ACCORDANCE WITH THE POLICY PROVISIONS. _ '. AUTHORIZED REPRESENTATIVE r -01988-2009 ACORD CORPORATION:All rights reserved. .CORD 25(2009/09) .1 of 1 The ACORD name and logo•are registered marks of ACORD - ` - •• .5 ##S77368/M68179 s MEY ' r _ r The Comm-onweah,h of Afassachusetts' Department of lnrlustrial Accidents' Office ofI pvestigations 600 Wash'M ton Street Boston, AIA 02111, _ ' www-mass.gov/dia Workers' Compensation Insurance'Affidavit'Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Lejjibly Name (Business/Organizatiort/lndividual). Address:. City/State/Zip: n "C4 1_` Phone #: 1 Are you an employer. C cic the appropriate box: " -. , Type of project(required): I. 1 am a employer with_ Z '4 ❑ I-am a-eneial contractor and I employeesemployer and/or part?* have hired the sub-contractors 6. ❑ New`construction 2.❑ l am a sole proprietor or partner- listed on the attached sheet. 7. .❑ Re tnodelin j ' ship and have no'em to�ees These sub-contractors have g, El Demolition'. working.for me in an capacity. employees,rind have workers' i Y�c� p �'- 9. '❑ Building addition , [No workers' comp. insurance comp. insurance.$ required.] 5. ❑ We.are a corporation and its 10.[]'Electric*a repairs or additions , 3.❑ 1 am a homeowner doing all work > •officers have exercised their 11.❑ Plumbing repairs or additions myself. No workers' comp. �` right of exerrtption per MGL Y [ p• +12*E] Roof repairs insurance required:] t c.452, §1(4),and we have no ° employees. [No workers' 13.0 Other• _ ,. comp.•itistirance required:] V' *Any applicant that checks box#1 must also fill out the section below showing their workers'.compensation policy information. 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. C tll / ,, �.}• , Insurance Company Name: T��q�t/GtoAI,Somri re -. Policy#or Self-ins. Cic. #: W'(-A Expiration Date: , Job Site Address: City/State/Zip: a 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 NIGL c. 152 can lead to the imposition of criminal penalties of a` tine 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 tine 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 D1A.for insurance c'overage.verification. I do hereby certify u e pains and penalties`of perjury that the information provided above is true and correct. Sivnature: Date: Phone#:' _ Official ipse only. Do not wrtte� n this'area,,to be completed by city or town official � . z City or Town': Permit/License# `' .• `-,. 4 Issuing Authority(circle one): 1. Board of Health 2.•B'uilding Department 3.°City/To(vn Clerk 4: Electrical Inspector` 5. Plumbing Inspector 6.Other Contact Person: Phone#:' OWNER AUTHORIZATION FORM (Owner's Name) i r • . owner of the property located at , aye . a� � -.A � . • - . (Property Address) (Property Address) hereby authorize Gc 1 ion (Subcontr or) an authorized subcontractor for RISE Engineering, to act on my behalf to obtain a building permit and to perform work on my property. Y f Owner's Si nature Ar" Date of Town of Barnstable *Permit# 04 t° �e Ex ires sue d 6 months from is P f _ ate X"S. Regulatory Services Fee r , i6 �0 Thomas F.Geiler,Director prEDN1Pjp Building Division X-PRESS PERMIT . Tom Perry, Building Commissioner AUG 2 5 2004 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 TOWN OF BARNSTABLE EXPRESS PERNUT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Iq tap/parcel Number 'roperty Address 40 �2 6'6co � 'Residential Value of Work �� Q Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address Contractor's Name 'G f�A-�¢ ,c Z� Telephone Number 7 Q'' ,a Home Improvement Contractor License#(if applicable) / d 2 3 J—� Construction Supervisor's License#(if applicable) �r 7WorkmanIs Compensation Insurance Che�c ue: � �l am a sole proprietor ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance [assurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate'must be on file. Permit Request(check box) Re-roof(stripping old shingles) All construction debris will be taken to ❑•Re-roof(not stripping. Going over existing layers of roof) 0 Re-side ❑ Replacement Windows. U-Value (maximum.44) *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. me rovement ontractors License is required I Signature Results Page 1 of I% Home Improvement Contractor Look Up Enter Search terms separated by spaces. Search terms can be Town/City, Name, or License number Select Search type: OF; AND C) OR Search Search Results Reg. No. Ap licant Stat Street City e Name ITitle Expiration PETER G. 75 Betty's Pond Mandravelis, 102359 MANDRAVELIS Road Hyannis 02601 Peter Owner 7/1/2006 Total of I Records matched. Back to Home Page BBRS Privacy Statement http://db.state.ma.us/bbrs/hic.pl 8/25/2004 I 4 Town of Barnstable . vpfKHrtTOk�Q� Reguxatoxy Services .� Thomas� Geiler,�irectar $adding Division lFD tN' Tomperry, Bun tng Commissioner 200 Main Street, Hyannis:MA 02601 . _ _. �,to�,barnstable.maus --• Fax: 508-790-6230 pffcce: 508.862r4038 . .. - pro exty owner-Must -Complete and. Sign This Section if Using ABuilder • G` �=. .: ,as Owner of the subject property r r G-*k_ - . to act on lnybe�ialf, hereby authorize ' in matters relative to work authorized by this budding permit application for, - a - (Addxeso of job) - .. S'sgn of Owner ^�(, r Cr — printN•ame '� •. .a� srn,;,,:� � r. .. +'".'3.r is „ :: -i.a,} +. -` ,.s�.ad � ,�z `b`" `s... y [� .' 4 WIN Q t 0 /4-- 9 Lam-- <0 a. CfaT f F I E D P-LOT P L A_N L O C AT I O N SCALE: l'` .�� " :D'ATE. S-z7-ems R E F-E-R E N C E: covAfT fL/9 N 7- Z74 2 $ D A E (so A- HEREBY CERTIFY THAT THE BUILDING G. LA 14 D SURVE OR. SHOWN ON THIS PLAN IS LOCATED ON THE GROUND AS SHOWN HEREON AND °THAT' lT CO N FORM TO THE ZO�N ( N G BY - LAWS OF .THE TOWN OF tNOFM4`sq gge�sTAC3GE W H E N C ONSTRUCTE D. �° GEORGE may. tj � Gn BARNSTAB.LE- SURVEY CONSULTANTS, tNC. -7,Q;STE�```° • VV E S T Y A R i►R 0 U -Ct�i,'M A S':S _ r '"" SURV - r 34. 1. 11 77: )67f VAIN low f •'', � • boOR Pic-b Rao M NI NA i 1 BAT,' � _ T�:x MMA SMOKE ALARM ( ) - HEAT DETECTOR 6-(H} will be required in the basement, or 1 (S.A. ) at top of basement stairs. \ r vvi �J Asse,*or's map and lot number .... .�..- ... l/ .RT�� �. INSTALLE. IN COW, JANGE Sewage Permit number .......... �� � lTH ARTICLE 11 7'A y CONDO OFTHE tp TOWN OF BA 1J y BAHBSTLBLE, i "6 9 .e� BUILDING INSPECTOR 'E0 M A`' APPLICATION FOR PERMIT TO ............ Jv.9.. .. ............................................................................................. TYPEOF CONSTRUCTION ................... `!R cn.....`¢-r.—.............................................................................. ................. .... �,�/2., ....19 TC THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the .following information: Location ....!!1�'�.......F.CL...........' !. `.� -:.......�� .........i.......l.J. .................................. ProposedUse ........ t. ..1.�.!.h/ .....................................................................................................I......................... Zoning District �.. ..............Fire District l7` /�/� `.5.................................... ............. �.. . . �.. Name of Owner ......:�4...` ..k...... .J�..............Address .................. �, L Name of Builder ...............Address .............. .`,... .�. ...........�^-..`./ .............................................................................. , L f G- - Nameof Architect ..................................................................Address ...................................................................................... Number of Rooms ............. .............................................Foundation .........n..................................................... Exterior ........ .........�^` .4.�11 �5'...................Roofing ........._.......W..,. ..................................... 9 ' f t Floors ................�}t 1 ..................................Interior .............� ..�......... G ................................. �'` !. H.eating ............ !/{ .........6.1 .r-C�•C(. ................Plumbing ...............1......... . Fireplace ..............,................P—L .p.Rk°'.`..................Approximate Cost ..............z. ......C.V../ Definitive Plan Approved by Planning Board ________________________________19--------. Area .....(r. l...sc.....'............ Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name .... ... ......... ... ... Smith, J. K. t 17720 one story, N .................-Parmi for .................................... I 4 single family dwelling ............................................................................... location Athlone Way Hyannis ............................................................................... . Owner J. K. Smith i Type of Construction frame ................................................................................ Plot ............................ Lot ...........#89............... 1 r Permit Granted ...........JuN�..3................19 75 'E l ' Date of Inspection .... ...... ........................19 I Date Completed ...................19 - 1 PERMIT REFUSED }} ................................................................ 19 I a f ......................................... ................................. +, T: ........... ................................................................. e. ............................................................................... ............................................................................... i Approved i ............................................................................... ............................................................................... C, Assessor's map and lot number r.................................... , Sewage Permit number ........... ...<............. .......................... TOWN OF BARNI STABLE • BARNSTA63 9.BLE. M AS& 1 0 M BUILDING ' INSPECTOR APPLICATION FOR PERMIT TO ............. ............................................................................................. TYPE OF CONSTRUCTION ....................A—"A ................................................................................................................. .................. TO-THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location .... Cj..1......... ............ ..........................:�................. Proposed Use .........C� r... ........ ... .............................................................................................................................................................. Zoning District .............e Fire District 5................................... ..........!................................................ ......... 1%.Ie/ e of Owner ...................................................................... C11, Nam V S�� Address .................. ............ .......V... ..........Address ...................Name of Builder ................ .. ............ ......... ................................................................. Nameof Architect ..................................................................Address ..................................................................................... Number of Rooms ............. cc ...................................................Foundation ............................................................................... Exierior ........<7 J.0 11 �, AIK-1— r ...Roofing ...............q � /,) ...................�s............... ......................................................... WA 12 4 ../.....6 C/C_i-r, Floors ................... ..................................................................Interior .............. ................................................ Heating .......... .........J,�. q 4 ( x- .................4,!................Plumbing ................/.......... ................................. Fireplace .............. 4 1 0- ,1 St .............. ............ .......................... ...................Approximate Co ... ............ Definitive Plan Approved by Planning Board --------------------------------19--------- Area ..... ................................ Diagram of Lot and Building with Dimensions Fee ...... ..................................... SUBJECT TO APPROVAL OF BOARD OF HEALTH 6o N 2.,0 I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name .......\a ...................AL......... U Smith, J. K. XNZNXMX . 291~299 � ` 17720 one story, ` No -----.,^pe,rn. Ffor -----------'` _ single family dwelling --'' ' Locon -----n- '-' . ....-- ` Hyannis ' ........-----------.. . ,, K. ..�.. "w= � / of Construction ----- ' , Z #.8*9 PlotLotDate of Inspection .....Z..........................19 —` � ""= Completed � ....................../E IR.M.I.T R.EFUSED........... � � � 19 -----' -------------^^----- ` ............... ............................................................... � � ........... � � --~--------.—.--.-----.—.—.—~. Approved 1*9 � . -----------...—,-----,---.---. ^ --------------------'''—^—'-^— '