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0177 BISHOPS TERRACE
Towne of Barnstable � F�p=tr_r a7ss a irstre date Re-aktory SemiceS fee MAC q,U � 1639. �� Thomas F Geffe r,Dixectar TOWN O �.E g D"iion TOMPeaxy,CSO, BUU&ng CoMn]5sioner 2001vlak tree;Hydras_MA 02601 www.townba=shab]e ma m Office: 508-862-4038 Fa _508-790-6230 EMPRESS PERAM APPLICATION! - R�CjD + li .L ONLY O tlTazYalidsvisltorulZedXresslmprbn MaplparcelNumber ProperryAddress I Orly l �S ► �F XR esVale o#�vork S b yyl! �nrafee of.S3S.OU fo word,:umd r S6000vvnsr's N=m&Address r Z vk- ! Cc=amn's Name 'l ` Telegbxrz N er ti HJ omeImprov Como=ctorLkeose=(ifapplirabk)_1053�0 � ', (�iYz rCo �C� -G 1 C)('1 Cor�soc�oaStrgervisor'sLic�T(ifappluable) � wok's Corxpe�satinnitrarue check one: ❑ I ama sole props mr I have worixees mpensaS6n lns==ce G r 1 /� Insuaan Co y�Na I s -�. � JU �Q chi CID 1 Worl's Corm.POT=Y= � Copy ofT swmce COmPlignee Cerdficata must accompajffv each pemriL Permu (cbeckbox) t^ ( J Re-r00f(hUxr: m-=Aed)(smippuqg_old s ) AiLconstnxtiondebriswMbe t2kenYo e(hvondeane nailed)(not stoPFa Goit over_tMisting layers ofmof) ❑ p3ace�oaeruSViudowsldoors/s3iders.U:Valrxe ( 3�nofwi0ows 'P r ofdcas_ ❑ Smoke/Carbcn.Mormxide detectors 4 fIoorplsns maxked with rad S and inspections regn¢md. Separate Mectmied&Eve Per wits required_ '�k�e:eavized:Is.�ea��nazaadoaaatacempsacmp7mnceuichasbeto+ascdc+z�;urrarego}acas,i�HaxasiCCa�cv.�i�,as '*'Note: Pro penyOwnerx�scsi�gt,�e Y0VPMrT*tMrofPexuzissian A copy. of required.*e Home improvement:Contractors Ucease&Construction.Supervisors Iieexrse is i' C 1T7sasldxolBcLlp�DazaV,ocai�Miaetofi.WadoaslTemgeraxySmm��9s\Caicarto�iook�S2;68DtrAu�FSS.doe Revised 061313 Fraser Construction, LLC 31 Bowdoin Rd. Mashpee, MA ®2649 Email: info@fraserconstructioncapecod.com ry -' www.fraserconstructioncapecod.com FAX 1-508-428-0123/ PHONE 1-508-428-2292 HICL#112536 CS#97668 ICE-ROOFING PROPOSAL DATE March 20, 2015 PHONE: 508-775-8190 NAME: Bob Drake EMAIL: c�// 7 i MAIL ADDRESS: JOB ADDRESS: 177 Bishop Terrace Hyannis, MA 02501 FRASER CONSTRUCTION hereby proposes to perform the following services in a neat, professional like manner in accordance with the manufacturer's.specifications and local building code. -Remove and Haul away all of the old roofing material -Re-nail all plywood sheathing as needed. Fraser Construction will include a 4 Star Upgraded warranty with the selection of any 30 year shingles or any Lifetime shingles. 4 Star Warranties have a 50 year Non-Prorated Coverage in case of any warranty repair, labor and materials, shingle tear-off and disposal fees. CertainTeed SureStart Plus- The extra measure of protection when a credentialed company installs an Integrity Roof System. ASK CIS ABOUT OUR OVERREAD CARE CLUB! - a Asphalt Material Options Supply and Install - CERTAINTEED LANDMARK PRO ARCHITECTURAL ASPHALT SHINGLE - Lifetime, Limited Transferable Warranty - Class A-Fire Rated - 250-270 lbs. per square - Two Piece multi-layered Laminated Fiber Glass Construction - Classic Shades and dimensional appearance of natural wood or slate - Max Def Color Selection offer a more vibrant, brighter appearance with a richer mixture of surface granules that provide a more profound depth of color - Manufactured with Self-Adhesive Strips and fastened with six nails in common bond, large nailing area - 15 year warranty against Algae containment causing discoloration and streaking - 15 year wind-resistance warranty up to 130 MPH Color: PRICE-$15,525 Initial+ * Price includes ice and water barrier on entire back dormer * Price includes removal and replacement of White Cedar siding on back right cheek above roof line and front right main cheek above roof line * Price to remove and replace back left cheek white cedar siding. Price includes ice and water barrier run up vertical wall, and flashed with 16 oz red copper flashing. Specifics apply to all siding above roof line. Price $695 Initial Skylights - Replace skylights on front main with Velux M06 units (options below) IA) Supply and install Velux M06 Fixed Skylights Price: $1,495 each Initial: 1B) Supply and install Velux M06 Manual Venting Skylights Price: $1,995 each Initial: uo 1C) Supply and install Velux M06 Venting Solar Powered Skylights with factory owered blind color: white. Please circle blind choice Light Filtering or Light Block Bl---_innd Price: $2,695 each • Initial: - 30% Federal Solar Tax Credit($808.50) Total Investment after Tax Credit: $1,886.50 each 2 II `n s 2) Add factory installed solar powered blinds color: white to Manual Venting or Fixed units if applicable. Please circle blind choice Light Filtering or Light Block Price: $500 each Initial: - 30% Federal Solar Tax Credit($150) Total Investment after Tax Credit: $350 each Skylights installed with Velux Manufacturer's warranty for the duration of 20 years on the glass, 10 years, No leak Warranty on the unit and 5 years on blinds and controls. * Please note that the 30% Federal Solar Tax Credit is only applicable to Solar skylight units and Solar blinds. The Federal Tax Credit is credited to the homeowner when he/she submits their taxes at the end of the year. Federal tax Credit is contingent upon Federal Tax eligibility. Please consult with a tax professional for more information on solar tax credits. For more information on Federal Tax Credit please go to www.veluxusa.com Roofing Product & Installation Details Supply & Install - (Soffit Venting) Hick's Ventilated Drip Edge or 8" Aluminum Drip Edge with existing soffit vents. Smart vents over white drip edge. Protection against damage to the roofing materials and structure. The most effective system is a balance of air intake and exhaust that creates a uniform flow of air through the attic. This system creates a condition in which the roof temperature is equalized from top to bottom, supplying a uniform air flow along the entire underside of the roof deck. Supply & Install - Ice & Water shield Waterproof Underlayment System (3ft. on eves and valleys, 18" on rakes, walls, and skylights) Ice and Water Shield is a self-adhering . roofing underlayment used on critical roof areas such as eaves, rakes, ridges, valleys, dormers and skylights to protect roofing structures and interior spaces from water penetration caused by wind-driven rain and ice dams. Supply & Install - Surround Underlayment (A Typar Brand) A smart alternative to felt, it is water's toughest opponent, creating a secondary water barrier that reduces`the L 3 ' incidence of leaks caused by storm damage, wind-driven rain, ice dams and worn roofing materials. It is a waterproof, synthetic polymer material that will protect your home against moisture intrusion. Supply & Install- CertainTeed Swift Start With self- adhering asphalt starter course on all eves, and rake edges. CertainTeed requires this product for Integrity Roof Systems and upgraded wind 'warranties. c Supply & Install -Aluminum & Neoprene Soil Pipe Flashing Supply & Install- CertainTeed Ridge Vent High performance ridge vent with external baffle. Supply & Install -Pre-Cut CertainTeed Hip & Ridge shingles Shingle Ridge meets the hip and ridge accessory requirements for the CertainTeed Integrity Roof System which is comprised of underlayment, shingles, accessory products and ventilation all working together. The Integrity Roof System is designed to provide optimum performance--no matter how bad the weather conditions are. (As recommended by CertainTeed) Clean & Remove - Debris from work area daily. r PAYMENTS ARE DUE IMMEDIATELY AFTER.J®D COMPLETION. 1/3 initial payment, remainder to be paid upon completion Payments accepted are: CASH - CHECK - MASTERCARD -VISA-AMERICAN EXPRESS *Any payments not immediately paid upon job completion will be charged 0.005%for every day after the given 5 day grace period upon_day of job completion. * Please note that roof prices reflect removal of(1) layer of existing roof unless otherwise indicated in contract. If additional layer or layers are removed additional charges will be assessed. 4 Possible Extra-After the shingles are removed from the roof, we will lift one sheet of plywood to make sure that the insulation is not up against the plywood sheathing preventing ventilation from the eaves to the ridge. ,If it is, ventilation panels will be installed by; removing the plywood sheathing, installing the panels, turning the plywood over and then re-installing the plywood. If needed, this would be charged for as an extra at the rate of$6.00 per panel including Materials & Labor. There are 6 Panels per sheet of plywood. Possible Extra-Any,rotted or otherwise deteriorated trim boards, plywood sheathing, lead flashing, or other carpentry needing replacement will be done and charged for as an extra at the rate of$75.00 per hour, plus 20% mark-up materials. FRASER CONSTRUCTION Warranties the labor for LIFETIME of roof. FRASER CONSTRUCTION Warranties the shingles against Blow-Offs for 15 years. CERTAINTEED Warranties the shingles and labor 100% through the Sure Start Warranty duration. CERTAINTEED Warranties the shingles to be ALGAE resistant for the duration of the Sure Start Warranty depending on the shingle that was purchased. Please note that all pricing is contingent upon current market pricing. If contract is not accepted within thirty days of date of proposal, change in price may occur due to deviation in material price. Any deviation or alteration from above specification will be executed upon written orders and will become an extra charge over and above the estimate. All agreements contingent upon strikes, accidents or delays are beyond our control. Owner should carry fire, tornado and other necessary insurance upon the above work. We, if not accepted within thirty days may withdraw this proposal. FRASER CONSTRUCTION, LLC: Carries Workman's Compensation and Public Liability Insurance on the above work, certificate available upon request. 5 DATE OF ACCEPTANCE: Homeowner Fras r Constrncticin LLC f 6 Office of Consumer Affairs and Business Regulation 10 Park Plaza- Suite 5 170 Boston,Massachusetts 02116 Home Improvement Contractor Registration Registration: 112536 Type: DBA Expirafon: 3/23/2017 Tru 263597 FRASER CONSTRUCTION CO. DEAN ERASER P.O. BOX 1845 CO T UIT, MA 02635 Update Address and return card-Mark reason for change. scar 20M-05n1 C1 Address r7 IRenewaI E] Employment Lost Card �',�e�pcmxmeoaawaald o,��/�at✓uceGt� Office of eons Amer Fairs&Business Iie Iafon License or registration valid for individul use only y OME FMPROYENIEI�Ti CONTRACTOR before the expiration date. If found return to: istration: 112536 Type: Office of Consumer Affairs and Business Regulation F`xpitaiiors: •3/23/2017 DBA 10 Par)t Plaza-Suite 5170 • • . FRASER CONSTRUCTION CO. Boston,MA 02115 DEAN FRASER 104 M'MN NA EN LANE E FALMOUTH,MA 02536 Uadersecramry Not valid without signature t yt Y i a' + tvlassneh�lsckt3 •DefMitmont of Pul'illo SaNty Boatrrt oPRltitdigg Repufnflhns anti Stnntialcis CtlnstrHS[foil sliporrttor " License,CS.007608 104 lvngN VIAW XIAZ` t{ IT 1 � Cumrntas)oner 06l07/1t)�5 s r FRASC-ON-01 PAAS �..._- CERTIFICATE OF LIABILITY INSURANCE Da 9129/20IIJDlY'144 i28/ 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 I3ETUIFEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AN D THE CERTIFICATE HOLDER. IMPORTANT. If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain Pollcies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CON A Viveiros Insurance Agency,Inc. t548,676-0309 PN R Ashle Paiva HONS 375Airport Road Arc No Ext 508-689-2713 (ac.No): 548324-4553 Fall River,MA 02720 ADOREss:Aivn@)I-rveirosinsurance.com INSURER(S)AFFORDING COVERAGE NAICw INSURED Fraser Construction LLC INSUREZA:Granite State Insurance Co wsuRER6: pQ BOX 1845 INSURERC: COWR,MA 02635 INSURER D INSURERS: INSURERF: COVERAGES CERTIFICATE NUMBER REVISION NUMBER: THIS to TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSUP.ED 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. SR LTR TYPEDFINSURANCE INSR 4WD POUCYNuWBER rMMIDD rA1DOrlYYYI L@AIT$ GENERAL UABILn t _. EACHOCCURRENC'c S COMMERCIALGENERALUABILRY JA L PREMISES Eeacarrerce S CLAIMS-WADE OCCUR MEDEXP(Any cnePerson) S I PERSONAL&ADV INJURY $ GENERALAGGREGAT'e S GEN'LAGGRECATEUvIrrAppUESPER PRODUCTS-COMP/OPgGG $ POLICYR11 LOC I $ AUTOMOBILE LIABILITY - - COMBO S CaLt Ul:tl I Ea acctlentl S ANY AUTO SO DILY INJURY(P er psrso N S ALLOWNED SCHEDULED AUTOS AVTOS BODILYPIJURY(Per acid ept S i HIP.ED A'JTOS NON-OVYnIED AUTOS - $ 1 (PERAGCIOENTI UMBRELLALIAS S OCCUR EACH OCCURRENCE S EXCESS LABCLAIh1S�lADE AGGREGATE S DED RErenCN S - WORKJ RS C01APENSATION S AND EMPLOYERS'LIABILITY. X 70CRY��IM S OeM A ANY PROPRIETORIPARTNERIEXECUTIVE YIN WC009930601 9t2612014 9126l2015 (14andatory In N OFPICERAhIEMBER EXCLUDEDW NIA E L EACH ACCIDENT 500,0DO H) Ryes,desciJe wider EL DISEASE-EA EMPLOYE= S 500,000 DESCRPnONOFOpERATIONSDelOvi ELOISEASE-POL'CLTRT IS 500,000 DESCRIPTION OF OPERATIONS I LOCA71ONS I VEHCCLES(Attach ACORD 101,AddWonal Remarlm Schedule,ifinere space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THEABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of Barnstable Building Division TIME EXPIRATION DATE THEREOF. NOTICE WILL BE DEL(VERED in 200 Main Street ACCORDANCE WITH'ME POLICY PROVISIONS Hyannis,MA 02601- - - AUTHORRED REPRESENTATIVE O 1988-2010 ACORD CORPORATION. Ail rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks ofACORD r The Commonwealth ofMassachrtsetts IT" Department of Industrial Accidents Office oflnvestigations 600 Washington Street :x\ Boston,M 4 02111 www mass govIi a Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Ai3plicant Information Please Print Le�bl= Name(Business/Orga tion/Individuall Address: ). � ' )$L� p_ City/State/Zip: r� Miq Phone Are ydu an employer?Check the appropriate box: Type of project(required): L[ I am a employer with �© 4. ❑ 1 am a general contractor and I employees(full.and/or part-time).* have hired the sub-contractors 6. ❑New construction2.El I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. employees and have workers' insurance.+ 9. ❑Building addition [No workers'comp.inst?sance comp. required.] S. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.7 Pli mbin g repairs or additions myself.[No workers'comp, right of exemption per MGL insurance required.]t c. 152,§1(4),and we have no 12.0 Roof repairs employees. [No workers' 13.0 Other Comp.insurance required.]. , '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. lam an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: A r I J L 911V J115U_Ca0AT Col Policy#or Self-ins.Lic. ,Q_,,,_,•, ^_ Expiration Date: Job Site Address: In r) TD O1 City/State/Zip: � Attach a copy of the workers'compensation policy declaration page(showing the policy numbeqnd expiration date). Failure to secure coverage as required.under Section 25A of MGL e. 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 anal 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 under the pains and penalties of perjury that the information provided above is true and correct- Si ature: Date: 7 �� Phone#- �07 Official use only. Do not write in this area,to be completed by crey or town offuiaL City or Town: PermitlLicense# 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# r r TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION GB�s� to / 429s Map Parcel 9 �BT �1� Permit# (013 Health Division 10-_-->_ Date Issued Conservation Division TJI7Z��y Q Application Fee ®P Tax Collector Permit Fee ®o Treasurer SW.Lnnon wo112-3 Planning Dept. INV 3000'IVIN3WHO 8 3ULL HIVA Date Definitive Plan Approved by Planning Board 3ONYndW03 NI 037171Cow3 Historic-OKH Preservation/Hyannis 31315f1U1 L"2 a 2' Project Street Address _(7-� 3��hd p 5 T 6R. Village 14 VANn) t5 Owner Q c>b*2 i D Q A k6t Address S A fte Telephone 50 8 7 7-T 8►Ito Permit Request To C. 5 E in Tw a S LDe5 CDT l�o2c l-1 Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation i900- Construction Type t; oc570, Lot Size Grandfathered: ❑Yes ❑No ,If yes, attach supporting documentation. Dwelling Type: Single Family )d Two Family ❑ Multi-Family(#units) Age of Existing Structure 2S Historic House: ❑Yes ;lNo On Old King's Highway: ❑Yes Z No Basement Type: ❑ Full ❑Crawl ❑Walkout XOther CnwgcP_& 'E AD. 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: O Yes ❑No Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:LJ 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 BUILDER INFORMATION Name L.cvh G o u3 t-J E2 Telephone Number Address License# Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE Lo DATE Z0 a Z FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED MAP/PARCEL NO..- ' ADDRESS - VILLAGE OWNER DATE OF INSPECTION:ru FOUNDATION w Z _ r: r FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL :. PLUMBING: ROUGH FINAL'' 4.- I GAS: ROUGH .ax g €'I FINAL _ FINAL BUILDING i• !j 4 . DATE CLOSED OUT ASSOCIATION PLAN NO. ` ! Y" f The Commonwealth of Massachusetts K ' - Department of Industrial Accidents 600 Washington Street Boston,Mass. 02111 Workers' Com ensation Insurance Affidavit name �• �o� t�Ann.�' �d16 ��'�'�' location: �. yl hone# I am a homeowner perfomIng all work myself. ❑ I am a sole r rietor and have no one workin in capacity er rovidin workers'compensation for my employees working on this job. :: ? : :_:::::: :. :::: ::::,::: I am an em to p g ...........................::..::::::::::::::.::.:. .>:.:::.:::.:::::::::::::.::::::.:::::.:::.:.:;.::::::::..::::::::....:::.::::::;:::::::::::.;:.?:.?:.?:;;;;.?:.: ❑ ...P....y.............::.:.::::.::::::...:::::::.:.:..:::::::.: :.::::::..:....:..,::::.::::::::::::::::::::::..::.::::.::.:.......::..::.:.::.::.......:.::::::::::::::.:........::.:::.: X. ::::. ..:.......::.:::::..:.:...........:.:::::::...:...... con address ::....................:......................,.:.........................::..:......................... ;.; ..::.: ..:?>;:::.: :..;.; ::»::::::: ..:...:. .... X. X. ❑ I am a sole proprietor,general contractor,or homeowner(circle one)and have hired the contractors listed below who have rkers'compensation polices: the followm w P................ aw :.:::::::::::::::.:::.::::,:::::::::::: :.:.....:::::::::::.::::::::::::::::::::::::::::....::::::::.::..:::::::.;:.?:.>:.?:.?:.::.???,? .; .......... an::name: _ __ X.::.:. >< :..:•; ...................................... z«. .......::.:..... xx Now address. :.: .......:......:::.:.......:::•:::.::.:::..: FaSm a to seeuro coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a Sae to$1,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a Ste of$100.00 a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage veriScation. I do hereby th pains and walties o perjury that the information provided above is true anAAd coned Sigziature er'l.S�� i� Date Print name,"R06 L=A VI/ Phone# official use only do not write in this area to be completed by city or town official permit/license# ❑BuSding Department city or town- ❑Licensing Board ❑checkif immnediale response is required []Selectmen's Office oHealih Department contact person: phone#; ❑Other gigs ern) Information and Instructions ,I Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the"law", an employee is defined as every person in the service of another under any contract of hire, express or implied, oral or written. (�r_ 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 r i 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 th6'grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer. MGL chapter 152 section 25 also states that every state or 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,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 in the workers' compensation affidavit completely,by checking the box that applies to your situation and supplying company names,address and phone numbers along with a certificate of insurance as all affidavits may be submitted to the Department of Industrial Accidents for confirmation of 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. City or Towns 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. The affidavits maybe returned to 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 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 0mce of Investigations 600 Washington Street Boston, Ma. 02111 fax#: (617) 727-7749 phone#: (617) 727-4900 ext. 406, 409 or 375 °FZHE lo,�, Town of Barnstable Regulatory Services BAMSTABLE MAS& Thomas F.Geiler,Director . a`0� Buildin Division g Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction, alterations,renovation,repair,modernization,conversion, improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions, along with other requirements. �G K Type of Work: �®R,G14 i Estimated Cost Sao Address of Work: l ?7 Owner's Name: R o6 a Q i vy t7 RSA Kam''' Date of Application: t3 AV Zo°o`Z 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: Date Contractor Name Registration No. i n t3 Ateh 'Z�Z " ow. �..�,a►-�- Date Owner's Name Q:fomts:homeaffidav y ' J Q^� •,� rt3 ❑ 5 zz i�G�� PZ14 i - � • �x/S Tj�� �{ovSc- J�/o , tv.9-// c'�'k+sriiyl,' w i � _h � � . � Q k � - � �f �� o � II � _ _. ._-— 2 .ti � k c. � �. j L . � c t i � y � ' _` � � � 4 � �J � 3 _ � / �� �' �� J'� 2 j L«,/z �L,�-�J t II 10 -® p� i 4 4 2x10 S2AF�ER- a i { ^cry S,J23 , 2 {SQ� �Se� aSrab�r� �- ly <s=`.,yam � „ a C'lZo 55 S�'c i to,.J pN7 ✓�L'�g��! C" f`•W' ?il".��(`f^'f l�✓� {N,?{� �g•Jr, �3 i ',1 a p, p ?y•pr hwi' tis('}r rs,. �ly i ,4 i MA ?wqV��d�tj @t�� A�y {•I �%yt �Yx rF t d 7 kF 1'£F t�r -§,y 1 ,��y(�f pair,' �y.`y .,..fir 2 F#`� l� - J �� sn{}I J r£y� n '�� '"r&,,,> �4 i�'Y3t N Yfu•T 'tx. v7 OEM; IQ100 fi`` Mac i t Y}ll i d9 Siyyt $ r! 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Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION /� Please Print DATE: 13 401 7Zm0'Z JOB LOCATION: 1-7-7 ►30. �+on 5 TEA �y+A�JNis VNra1 number street village "HOMEOWNER': l\d�LYLt" W.�R.AKL -77- V qd S Cg U6� 4'7ZK name ((�� --� home phone# work phone# CURRENT MAILING ADDRESS: RaL ear DP--m t7'Z e stycp`g Tin 14)A#JN15 MA 0264O city/town state zip code The current exemption for"homeowners"was extended to include owner-occupieddwelling dwellin of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be, a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed tinder the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements �' D _ Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger,will be required to comply with the State Building Code Section_ 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such, work that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:forms:homeexempt TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION ' Map ZS ('t Parcel --• "t - Permit# "7OE 261 Health Division Date Issued Conservation Division Fee Tax Collector Treasurer Planning Dept. § h Date Definitive Plan Approved by Planning Board ' Historic-OKH Preservation/Hyannis Project Street.Address _77 � ��� p`� Te�i _V h-CL Village i}N A) i S + Owner o Address Telephone' 7 S —SS t a Permit Request 0' �r [4 o 0 v� sfi g 4 Square feet: 1st floor:existing proposed 2nd floor: existing. proposed Total new Estimated Project Cost C_�vo Zoning District Flood Plain Groundwater Overlay Construction Type t Lot Size Grandfath_ered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units) • Age of Existing Structure Z D V P-S Historic House: ❑Yes �11 No. On Old King's.Highway:"❑Yes ANo Basement Type: N Full ❑Crawl ❑Walkout ❑Other ' Basement Finished Area(sq.ft.) V4 6 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:0 existing ❑new size Other:' Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# Current Use Proposed Use BUILDER INFORMATION Name cR T- R A-VC 'Telephone Number ,,Address 1-73 i ��S C—P, License# Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS'PROJECT WILL BE TAKEN TO 4 1 �SIGNATURE 1 J�,�.Q�.� DATE � • i FOR OFFICIAL USE ONLY PERMIT NO. F . - ; • w ` . •- �a - � .., DATE ISSUEDs- MAP/PARCEL NO. v . ADDRESS `t VILLAGE - OWNER DATE OF INSPECTION;, FOUNDATION FRAME INSULATION - r { FIREPLACE ELECTRICAL: ROUGH FINAL t ` PLUMBING: ,ROUGH FINAL- GAS: TROUGH ` FINAL' FINAL BUILDING 142--sl ao DATE CLOSED OUT ASSOCIATION_PLAN NO. # The Town of Barnstable Department of Health Safety and Environmental Services- Building Division 367 Main Street,Hyannis MA 02601 Office: 508-862-4038 Ralph Crossen Fax: 508-790-6230 Building'Commissioner Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION ' MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. Type of Work: R c Roe F Estimated Cost C-3 o,— Address of Work: kCD6 i C--z. k v dk.N A E S Owner's Name: k o b 0 lz+ D tzp,le Date of Application: I hereby certify that: Registration is not required for the following reason(s): Work excluded by law J'Job Under S1,000 Building not owner-occupied 1211owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner. Date Contractor Name Registration No. OR Date Owner's Name g1orms:Affidav - - - The 6mmonwealth of Massachusetts + =-� ;- =- Department of Industrial Accidents °' ti- OIfiC80f//IYBSIlg81%O/1S <= .. 600 Washington Street � Boston Mass. 02111 Workers' Compensation Insurance Affidavit FM 0 name: � c � l:izi � p•xkL location: l 7 7 (2S. }Si S 1 t:(Z P R C c city I L6 lik 0 phone# -7?S—19 4 0 I am a homeowner performing all work myself. ❑ I am a sole proprietor and have no one workin in anv c�a��acity %%%%/%%% %//% ///% /%/%��//////////////%e %/% /% %%%%%%/%%/% // ❑ I am an employer providing tivorkers compensation for my employees working on this job. comnnnv name: address: city' phone#: insurance co. oiicv# ❑ I am a sole proprietor, general contractor, or homeowner(circle one)and have hired the contractors listed below who have the follo«ing workers' compensation polices: comnnnv•name: address city phone#r in9urnnce co. oitev#.. comnnnv name- :..:;:.;:•;:•;:.:;.,,.,. . address citri- phone#' lmnrnnce co. ;>.::. oiicv# Failure to secure coverage as required under Section 15A of MGL 152 can lead to the imposition of criminal penalties of a tlne up to S1,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a tine of S100.00 a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage veriffcation. I do hereby certify under the pains and penalties of perjury that the information provided above is trap.and correct Sizuture �. Date Print name Phone# official use only do not write in this area to be completed by city or town otIIcisl city or town: permit/license# ❑Building Department ❑Licensing Board ❑check if immediate response is required ❑Selectmen's Office ❑Health Department contact person: phone#; ❑Other (mvea 9,95 PJA) if Information and Instructions �. Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for th=*" employees. As quoted from the "law", an employee is defined as every person in the service of another under any cc=-.:z 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 cr the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the rec.z•e: 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 grounas c: building appurtenant thereto shall not because of such employment be deemed to be an employer. MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or renew of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who 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 chapter have been presented to the contracting authority. Applicants Please fill in the workers' compensation affidavit completely, by checking the box that applies to your situation and supplying company names, address and phone numbers along with a certificate of ins,,,-rose as all affidavits may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and - d'ate the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the"law"or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. City or Towns Please be sure that the affidavit is complete and 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 cortt=you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. The affidavits may be retiuned io the Department by mail or FAX unless other arrangements have bees made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions. please do not hesitate to give us a call. T i--Department's address, telephone and fax number. The Commonwealth Of Massachusetts Department of Industrial Accidents Office of f lvestl0auans 600 Washington Street Boston; Ma. 02111 fax#: (617) 727-7749 phone #: (617) 727-4900 ext. 406, 409 or 375 The Town of Barnstable FVE' o Department of Health Safety and Environmental Services Building Division BAMSCABM ' 367 Main Street,Hyannis MA 02601 MAS& � 039. ptFD MA'1 A Office: 508-8624038 Ralph Crossen Fax: 508-790-6230 Building Commissioner HOMEOWNER LICENSE EXEMPTION q p Please Print DATE: JOB LOCATION: b—7 7 ', t . �c 9!J Dnumber streef village' �/ "HOMEOWNER": 6�ofO C�6 D P_Ak� -7-2'S �1`t C� 9 1 7 Z T name home phone# work phone# CURRENT MAILING ADDRESS: 1 7 7 t S 1J� 5 l 1=P_k A C ci /town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. ' DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said rocedures and requirements. Signature of Homeowner0 Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q,Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care to amend and adopt such a form/certification for use in your community. Q:FORMS:EXEMPTN TOWN OF BARNSTABLE BUILDING PERMIT-APPLICATION /4ap_ Z l Parcel - °t� Permit# S/ Health Division Date Issued 3 77 / Conservation,Division Fee �� / Tax Collector T, I4'1 /Treasurerr-0777_07779,; Il ' Planning Dept. Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street.Address t 7`) i S k A` Village Owner Address !�n► r -Telephone 7`7 $1 c y Permit Request �.77 RiP�� Square feet: 1st floor:esting proposed 2nd floor: existing proposed Total new Estimated Project Cost 5 O G Zoning District Flood Plain Groundwater Overlay Construction Type Lot Size Grandfathered: ❑Yes ❑No If yes,attach supporting documentation. Dwelling Type: Single Family wTwo Family ❑ Multi-Family(#units) Age of Existing Structure 29 Historic House: ❑Yes No On Old King's Highway: ❑Yes Avo 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 ' r 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 Y 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 BUILDER INFORMATION - Name _ P(U iF i P-14-c Telephone Number 7 7 t C) Address l `7 1 (�,�p`� i k- License# '2 04 �q 14 v P,ay o i'S " Mk Home Improvement Contractor# , Worker's Compensation# ALL CONSTRUCTIONDEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE _ F� 1. y r r v FOR OFFICIAL USE ONLY PERMIT NO. `. DATE ISSUED `" , : "' • 4 y - .;• . _� r_ - MAP/PARCEL!NO. ADDRESS = VILLAGE . OWNER . DATE OF INSPECTION: # ` FOUNDATION ` # FRAME ti INSULATION FIREPLACE '. ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: S ROUGH y FINAL FINAL BUILDING S r z _ , DATE CLOSED OUT ASSOCIATION PLAN NO. ' The Town of Barnstable Department of Health Safety and Environmental Services-- Eo '' r Building Division ; 367 Main Street,Hyannis MA 02601 . Office: 508-862-4038 t Ralph Crossen f Fax: 508-790-6230 Building'Commissioner Permit no. Date ' AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. ' Type of Work: Estimated CostO C7 Address of Work: l `? l c S(,ti v p `5 rc'Z 14 y64 N Nc S Xuner.s Name: tw Zak ate of Application: 0,PC A, C�e I hereby certify that: i Registration is not required for the following reason(s): ❑Work excluded by law lob Under S1,000 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., VA ��ts-�-✓� t.� l 21 c f 5" Date Contractor Name Registration No. OR Date Owner's Name i q:fortm:Affidav j_ The Commonwealth of Massachusetts j Department o Dep Industrial Accidents =' Office ofINYOS 9.00ns 600 Washington Street Boston,Mass. 02111 Workers' davit S4 nE�� 819YM�surance����������...........��������%��/��•: 11 Ei. /i�..��� /i name: 20 — = location l 7 3 a\r,�i c71�S 1 L ./city v'`-Ntn.'CV MA hone# ❑ am a homeowner performing all work myself. I am a sole t)rovrietor and have no one lvorking in any capacity ❑ I am an employer providing workers' compensation for my employees working on this job. compnnv name address: city: phone#- insurance cn. piney# ❑ I am a sole proprietor, general contractor, or homeowner(circle one)and have hired the contractors listed below who have the folloning workers' compensation polices: comunnv name: address• dtv: phone* insurnnce cn. olityRE#.. :;::.::....:..:.: .,.. ///U, /,%/ /////.%/ comnanv name: .. . .................. :.: ... address: F. city. ... phone#= innurance co. ;..;: :::.;. Rolf CV Failure to secure coverage as required under Section ISA of MGL 152 can lead to the imposition of criminal penalties of a tine up to S1.500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a One of S100.00 a day against me. I understand that a copy of this statement may be forwarded to the ORlce of Investigations of the DIA for coverage verification. 1 do herebv cent' 'under the pains and penalties of perjury that the information provided above is truce d eorred Signature i" .l � Date Print name Phone# official use only do not write in this area to be completed by city or town oM ial city or town: permit/license ff ❑BuDe ❑Li ❑check if immediate response is required ❑Se ❑He❑OtI (trnaea 995 PJAi Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for th=' employees. As quoted from the "law", an employee is defined as every person in the service of another under any cozy- 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 tl•.e foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver 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 cr building appurtenant thereto shall not because of such employment be deemed to be an employer. MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or renewa- 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 chapter have been presented to the contracting authority. �/�i,�,'�,"�,,. Applicants Please fill in the workers' compensation affidavit completely, by checking the box that applies to your situation and .,supplying company names, address and phone numbers along with a certificate of insurance as all affidavits may be submitted to the Department of Industrial Accidents for confirmation of 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. City or Towns 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/licease number which will be used as a reference number. The affidavits may be returned io 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 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 Investloatlons 600 Washington Street Boston, Ma. 02111 fax#: (617) 727-7749 phone #: (617) 727-4900 ext. 406, 409 or 375 Department of Health Safety and Environmental Services o� Building Division t .MASS 367 Main Street,Hyannis MA 02601 _ aeas _ Office: 508-862-4038 Ralph Crossen Fax: 508-790-6230 Building Commissioner HOMEOWNER LICENSE EXEMPTION Please Print DATE: L 6 U✓I 2�('t lct`t`l JOB LOCATION: j 77 R,!A,;>fi S 1 L P_2kC�F 14 number street village "HOMEOWNER": {Cyb�,Qi w `J2A(�i✓ -7� 4?1`0 �C�<S 47 ZL name home phone# work phone# CURRENT MAILING ADDRESS: S 6,-C city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the buildW&permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems, particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care to amend and adopt such a form/certification for use in your community. Q:FORMS:F.7>O04" irequired unless same color/same materials specified on application Map/parcel number Sign-offs om: Tax Collector Treasurer ` . of squares of shingles or square footage of roof to be shingled 0pecify stripping old shingles or going over old roof. If going over Ohow many roof layers existing now Owhat size are rafters? What is span? Complete dwelling information for the Assessor's Dept. -if known []� Workman's Comp. form Home Improvement Contractor Affidavit(RESIDENTIAL ONLY Home Improvement Contractor's License OR Homeowner's License Exemption(RESIDENTIAL ONLY) Check expiration date on license COMMERCIAL WORK-No License is required. Fee q-f m-PERMns 1 Rev 6WS MALONE 1 30 98 . E 2 51198 , EE� �• ,f,F.., .,-., .t � � - JE� ><•iE� !�: \t� 3 Pf �,,. rad3E€� \� �E�€t.. 1 x x " ROBERT DRAKE 177 t BISHOP TERRACE r r I Ott EE t .y rr.» E9 ,i'.,..t ".,.E -1 � tt. d eu.� .:•r€Et)'E€.. - �,€€�tbr ,.. F nE a Anonymous i rn le N . pHigh school kids running a car repair business from this residence. They're also doing body i E" tli;f EE tE yC� work (fiberglass). " € 7-3 G E N r 5 x R € _ 3'� .'...€, nu, :t.• � :€ ,r oaks € tr E,rA� E Ej E E' t� ryS .. '� ¢E,.�. >::t LEE$ '�_ i€ -�•^`•1 ,,,,s3•...1 '• :i. �'��' �`, !rt 'r �tt€'� ........tti' 'aE';i a...E >E. ...tt:t. ?...:...E•'n � F ..''rt,.ttr E ... ..qt I �a i � -c QUERY PROPERTY: QUERY END QUERY PROPERTY PENTAMATION----------------------------------------------------------- 01/30/98 PARCEL ID 251 198 GEO ID 16285 LOT/BLOCK 46 DBA PROPERTY ADDRESS OWNER DRAKE 177 BISHOPS TERRACE ROBERT W TRS HYANNIS 177 BISHOP TERRACE HYANNIS MA 02601 PHONE DISTRICT HY DEVELOPMENT STATUS C ASSESSOR' S CODE CAPACITY (NOTES) ZONING DIST/ZOC RC-1 SEWER SYSTEM FLOOD PLN/ELEV. WATER SYSTEM OKH? # BEDROOMS ZBA DECISION FAMILY APT LOT SIZE 14810 .4 OPER/MGR NAME WET LANDS MULT ADDRESS USE 101 PROTECT DIST GP (N) EXT / (P) REVIOUS / NO (T) ES / PER(M) ITS / (V) IOLATIONS / (G) EOBASE / (E) XIT i [ ] [R251 198 . ] LOCI] 0177 BISHOPS TERRACE CTY] 07 TDS] 400 HY KEY] 162852 ----MAILING ADDRESS------- PCA] 1011 PCS] 00 YR] 00 PARENT] 0 DRAKE, ROBERT W TRS MAP] AREA] 50AC JV] MTG] 2001 177 BISHOP TERRACE SP1] SP21 SP31 UT11 UT21 . 34 SQ FT] 2312 HYANNIS MA 02601 AYB] 1973 EYB] 1975 OBS] CONST] 0000 LAND 26800 IMP 76200 OTHER 600 ----LEGAL DESCRIPTION---- TRUE MKT 103600 REA CLASSIFIED #LAND 1 26, 800 ASD LND 26800 ASD IMP 76200 ASD OTH 600 #BLDG(S) -CARD-1 1 76, 200 DESCRIPTION TAX YR CURRENT EXEMPT TAXABLE #OTHER FEATURE 1 600 TAX EXEMPT #PL 177 BISHOP TERRACE HY RESIDENT'L 103600 103600 103600 #DL LOT 46 OPEN SPACE #RR 0126 0131 COMMERCIAL #CL22 INDUSTRIAL #TAB 175 . 00 #FAB 175 . 00 EXEMPTIONS SALE] 08/93 PRICE] 1 ORB] C131023 AFD] I F LAST ACTIVITY] 08/14/97 PCR] Y ]�t1NIt� � • N •P • • t�. � ate.�/ _ � r J ut ! I �� a. Map .�( Parcel ermit# J J ~� Conservation Office(4th floor)(8:30 9:30/ 1:00- 2:00) 3 q _ Date Issued ._ 3 F Board of Health(3rd floor)(8:15 -9:30/1:00-4:45)e`,., Fee s ". Engineering Dept. (3rd floor) House# _ M $EPT7CVU -R S TA ST TEE 1ANCC' rd 19 . - ENVIRQN . ' TOEC TOWN OF BARNSTABLE �°� " '` =� Building Permit Application Pr 'ect eet Address r -7'7 S mD Village 44v A AJ rJ �S Owner (?U&&rJLA',nn. D(IAl<Vkddress Sl�rnd Telephone l goOF ' t ,'Permit Request 'o%&ha G C'X TE. )S t o P C. F e Z tt } :First Floor 1q4 square feet Second Floor square feet eoKD Estimated Project Cost $ Zoning District Flood Plain Water Protection Lot Size lz aC Grandfathered ? Zoning Board of Appeals Authorization Recorded Current Use C 64 as Q F Proposed Use <'&l k <TA 2 0r1 a Construction Type k(ap v C Residential Dwelling Type: „Single Family f Two Family Multi-Family Age of Existing Structure Basement Type: Finished Historic House Unfinished Old King's Highway A fo Number of Baths 0 No.of Bedrooms Total Room Count(not including baths) First Floor Heat Type and Fuel Central Air Ah Fireplaces Garage: Detached Other Detached Structures: Pool Attached Barn None Sheds Other Builder Information Name Pelee-,,- l zA tcar Telephone Number 7?:— L 4 O Address 1 7 7 j3, �� 7 r,�Q, License# 011 f 1 9 .i,i��✓►J LS Home Improvement Contractor# Worker's Compensation# NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO 'P i1t PLAC SIGNATURE f Z (;��. � DATE ,J c',v 6 �. BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S) FOR OFFICIAL USE ONLY PE MIT NO. DATE ISSUED MP/PARCEL NO.. ADDRESS x VILLAGE OWNER 1 + DATE OF INSPECTION: -• FOUNDATION FRAME; I f • d INSULATION FIREPLACE: ELECTRICAL: ROUGH FINAL PLUMBING: xROUGH FINAL ! , 31 -0 ZIP # k _ GAS: ice,. Roua 0 FINAL t r' FINAL BUILDING 2 -1 { DATE CLOSED 0U 172 f 1 1 1 ASSOCIATION P6A.I4 O. c + rnstable The Town of Ba ° Department of Health Safety and Environmental Services ]Building Division 367 Maier Stttet,Hyannis MA 0=1 Ralph Cro= Off= SOS-7903Z27 Buil�g C0= Faac 5os-775 3344 For office use only , Permit rto. Dau , • AFFIDAVIT HOME DWROVEMENT CONTRACTORI A supPLEMm-p TO PERMIT APPLI anon,alteration;rtaovation,�moderazmti°n,CO =on' MGL c. 142A requires that the"ttxo r c ed ranmai, demolition or aonsttuctioa of an addition to units m �� imprummem. are building containing at least one but not more shwa four darr3IingQo� bongo to such rtsidenee or building be done by rcgiUcrcd coauacxors,with=tdn requirements ©O po Type of Work: �►� A l7 t7 < Est. Cost n Address of Work•' L 1 % Qa-aer.Name: R � �j;:R 2*bG Date of Permit Application: I hazb♦certify that: Registration is not required for the foliming rrason(s): ` Work cmdudedby law Job wader SL,000 _Building not onmer-oocupied - =puiIutg own paw Notice is hereby giti7--n that: CO MIU10 CONtFtAC'T'ORS OWNERS PULLING TIMR OWN PST OR D WORK EALING W N UNRE �S TO TMFOR APPLICABLE HOME M'ROVEMENr ARBM ATION PROGRAM OR GUARANTY FUND UNDERMGL c 142A SIGNED UNDER pENiALTIES OF PEFJ=Y I hereby apply for a permit as the agent of the oauer: 3 - on NO. Date Contractor name OR f - �`'�' TheCllnlll101tN'caltlt of Atassacllusctts Department of Industrial Accidents ` _ ;Y . _M I� OIIICPa1/QYPSIl9al/OdS . 6(10 !f icslria�;;ton Street �• Workers' Compensation Insurance Afridavit ormatio location- S- Si 9 d I am a h eowner performing all work myself. .,AI am a sole proprietor and have no one working in any capacity •_ I am an employer providing workers' compensation for my employees working on this job. aidresr - city. phone#: . in�ur�nce co notice# 1 am a sole proprietor, general contractor, or homeowner(crrcle one)and have hired the contractors listed below who the following workers' compensation polices: Comflan't,n address- cin nhone#- insurnnce cn policy# - •-.� .. ., --- von ar.3...•saw�'seer+•r—Tre•ns�e,,�a _ �74Rai'T�+'� � a•�—r�'�'•�''(�14'i"S�'y-" nm am•name, Iddress- city- nhone#� insur•tn n rn "offer# Atiach additionai'shttef ff neeessa �: *'�^'°"' '"'�'r•`''!�-.`:•: '"""'•" •�� �" —�:":.r Failure io secure coverage as required under Section 3A of AIGL 152 can lead to the imposition of criminal pealties of s fine ap to S1.500.00 an! one.ears'imprisonment as well as civil penalties in the form of a STOP NVORK ORDER and a fine of S100.00 a day against me. 1 understand th• copy of this statement may be forwarded to the Once of Investigations of the D1A for coverage verification. I do herebt•certify under the pains and penallia of perjurr that the information provided above is true and correct: Si-2naiurc w unto 6 — 3 —94 /print name - one# - W 9 d otrCW-Use only do not write in this area to be completed by city or town ofilcial city or town: permit/lleease# r-ttlaitding Department (3Ucensing Hoard check if immediate response is required a5deetmea's Office 131lesith Department -Other_ contact person: phone#: VI information and Instructions a Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for emplo-mcs. As quoted from the "law", an enrplirnee is defined as every person in the service of another under an, contract of hire. express or implied. oral.or written. An enrph rer is defined as an individual. partnership. association. corporation or other legal entity. or any two or n the foregoing engaged in a joint enterprise. and including the legal representatives of a deceased employer, or the rccciver or trustee of an individual , partnership, association or other legal entity, employing employees. However owner of a dweiling 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 wort- on such dwelling or on.the _rounds or building appurtenant thereto shall not because of such employment be deemed to be an empic MGL cha.pier 152 section 25 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 ,%vho 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 chaps: been presented to the contracting authority. •.a.::. ..y.. .i•Mr•$ t•.:,A.: 4, yr• .ucrt:►• �r�-77 . . . .. .. Ji: t�t:,:r's. .�•:. :: .1:.. 1�w.";f,:iy r•i� •V.: :N•�:- vij.!..Nn►_ Applicants Please "l 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 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 requi: to obtain a workers' compensation policy, please call the Department at the number listed below. ..Jn-.ter `'•"'w'� '•"'•'r,•• - �. „•��. rss.. � - .�.'�.. .•�w... +..� .:.•�.;y,?.S•' —•..-'r.:"•�1�'.�rVy�.:y'•�' .�•.�..:7'J► •t:'l`ss'i•••... • City or Towns pri nted legibly. T7te Department has provided a space at the bottom and Please be a that the affidavit �s complete p ,. P sure 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. T7te 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 hesitate to give us a call. The Department's address. telephone and fax number. The Commonwealth Of iYlassachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,Ma. 02111 fax #: (617) 727-7749 7 727-4900 ext. 406, 409 or 375 phone #: (61 ) .. f TOWN OF BARNSTABLE BUILDING DEPARTMENT HOMEOWNER LICENSE EXEMPTION Please print. DATE JOB LOCATION ( 7? fJt^ ,S T fl IA N N IS IM R Number Street address Section of town "HOMEOWNER" Ro 6=a 7 l ) -2 ?�/ Name Home phone Work phone -t PRESENT MAILING ADDRESS City town Z6o ) 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 to six family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner" shall submit to the Building Official on a form acceptable to the Building Official, that he/she shall be responsible for all such work performed under the building permit. (Section 109. 1. 1) The undersigned "homeowner" assumes responsibility for compliance with the 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.q nts. HOMEOWNER'S SIGNATURE •� I APPROVAL OF BUILDING OFFICIAL Note: Three family dwellings 35, 000 cubic feet, or larger, will be required to comply with State Building Code Section 127. 0, Construction Control. HOME OWNER' S EXEMPTION The code state that: "Any Home Owner performing work for which a building permit is required shall be exempt from the provisions of this section (Section 109. 1 . 1 - Licensing of Construction Supervisors) ; provided that if a Home Owner engages a person (s) for hire to do such work, that such Home Owner shall act as supervisor. " Many Home Owners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q, Rules and Regulations for,. licensing �Con"struction 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 �bwner 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. Y care 'to ' amend and adopt such a form You may P form/certification'tion for use in your community. i T E R.2 A C Hy h N N 6, AIV Ar 99 ID6:< t NF.�l7m I 24� r-7 M 131 �i Tm p1g1'G�+ K Z- Z x 12 H ciR�C� Ex 2�G ZxtO �X `l LX Z � y T�ttl cx � Zxy .ti . a ivp. � 0( Assessor's map and lot number ..� a'..:. / ° ' �. �C� -�� �� - -- �*TH TOIL IeWage Permit number ..... ..,/1,�.�.. ... �..........3 ' SE f IN �SYMM M STALL A anLE, i House number ......>�.��....................:..........:......................... v7 ED tN CpM W11W TITLE 6 a gar a• TOWN OF' BARN-S'1'�v AL CODE AND UL APONS BUILDING, INSPECTOR APPLICATION FOR PERMIT TO .`........ps�.P.C.A..... ................................................:.......... TYPE .OF CONSTRUCTION ..................Wact. .................................................................................................... .:��...... .. 19.71. r ' ' ' TO STHE INSPECTOR 'OF BU.ILDINGS:` - The.undersigned hereby applies for a permit according to the following information: Location ....4 7..........43 ...T-§1R. - ProposedUse TkP&`:1... �'.,: �,h R �a. .............. ....................................................................................................................... r . Zoning District .....12...../............................................................Fire District ................. / Name of Owner ..."Ob ?..?...........�......a ka:' .:...Address ......C?? ..... .(z ......................... Name of Builder . ..............a...kKc"-................:......Address ...... ........34..,5' n?:5..... ......................... Name of Architect J�-o�'2r .........0.k ... . k ....................Address ......: ....... ........................ Number of Rooms "Fl ......Foundation ....W.L)Ke� Cc.n�C, ................................................................... 19 ...Roofing AS n/� -Cf Exterior .............? ........ ,....................................................... 'i1.!ti..T . f..... ....... ................... Floors ..... env.Rc;. . ........<zqQ!9G..........................................Interior .................................................................................... Heating .... ......Plumbing ........t irp• ....................................................... ........ Fireplace ........... Costc :. ......Definitive Plan Approved by Planning Board ________________________________19____._:, Area n ' Diagram of Lot and Building with Dimensions Fee .SUBJECT TO APPROVAL OF BOARD OF HEALTH 1 °3 1 i, Q I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name .. r..... �ti "�?'-................. Drake, Robert No ....... Permit for ......porch ............................................................................... Location ........... ......... . ............................Hyi,.=is.................................... Owner ............. Rob.ert..Jk.ak.e.... ......... Type of Construction .............fraMe.................. Plot ............................ Lot ................................ Permit Granted ........August..31........... ....... ..... .19 79 ��t-6-4 Id Date of Inspection....................................... Date Completed ........ 9 .......... 41 PERMIT REFUSED ................ ........ D.................................... 19 ...........M 4-v 47. ............ w. ..............I.G.p .15.......................................... vJ Approve'llf-.1 ..... 19 ................ .............................................. ................................................................................ .Assessor's map and lot number 7:'�.. ..................'cv 5 THE`�`1 t Hof r�� wa e^ Permit number �,� 4n/r �Q .. .:....,... ......... fi,•...:........... d Z BA"STADLE, i Housenumber ......................................................... y NAB& C� i639• 9� w ►=TOWN OF BARNSTABLE n G 0 [' _ 0 3 a � - _ BUILDING INSPECTOR APPLICATION FOR PERMIT TO ....................:..::.. ..................:.............................................................................. m TYPE OF CONSTRUCTION ................... z:a. ............................................................ ....................................... ........ram................. ............19:79 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: s . Location ... .7 7.. ti< �. �..?�.t?. �.� • �� �...... ProposedUse .........E.��.!?.�: ....`! ..<x. .:, .t"........................................................................................................................ ZoningDistrict ........................................................................Fire District .................................................e„"; ....................... Name of Owner ...<<4 .........D ........................Address .......k.2....1f 5 � �r . ..... I. :.:<`.g 2.......................... v Name of Builder ��� ............ ? Key........................Address ......I..2.2.......��.:`(,�, c i a Name of Architect .�'ca.�:=R �J ?� �• Address ......!.:?`?....... 1 .. .�z.:.:�:a,......�. �- ................................................. Number of Rooms ..................................................................Foundation .... C,�� ; ........................................................... Ekierior Y .........!.� ...a� &5 � i . . �. ............... ............ .................. ........................Roofing ..............��:r...........................�a..... • :1�' Floors1���,, ,-�� .Interior ......................:............................................................. Heatingaa Plumbing .................................................................................. ........................................................................ Fireplace ...........r .U.! !: ................................................. Approximate Cost . , x.......................... �........ ..... ..... .. Definitive Plan Approved by Planning Boar __________________________ .t�.�...........'�.......... ----_19_____--. Area Diagram of Lot and Building with Dimensions Fee ......................... SUBJECT TO APPROVAL OF BOARD OF HEALTH ts G I F ' L I hereby agree4to conform to all the Rules and Reg ulat o s of�the Town of Barnstable regarding the above construction. d I (} Name ..............................................` 1)................................. ` Y Drake, Robert� - A=251- No .... Permit for ...?1 'R....................... .IZc4 * ... ............................................................................... Location A22.....i3. ..... ......................... ..................................................... Owner ..... ............. ...... ..... Type of Construction .......................... ......................................... ..................................... Plot ............................ Lot Permit Granted August 31................................19 79 Date of Inspectio ....................................19 Date Completed. ......................................19 PE MIT REFUSED ............................................ ................... 19 / ... .............................. ............................................... ................................ ........................................... .................................... .......................................!..................................... Approved ................../.............................. 19 ....... ... ............................................................................... ................................................................................