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HomeMy WebLinkAbout0068 CARLOTTA AVENUE o Town of Barnstable *Permit# Expires 6 months fro issue date Regulatory Services Fee MAM Basxsr�. Richard V.Scali,Interim Director Building Division Tom Perry,CBO,Building CommissiXr PRESS PERMOT 200 Main Street,Hyannis,MA 02601 JUL 2 2015 www.town.bamstablEma.us (L Office: 508-862-403 8 �•�•�►r��p � .�;,S��7L C 6230 I V V V EXPRESS PERMIT APPLICATION - RESIDE Not Vaud withoutRerlX-Press Imprint 1 Tap/parcel Number R Yk12Q Property Address (D �D # 4-Q`TJ9 �/, w�s Residential Value of Work$ t� 67l/+ Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address RAM aN 4 >< I AV UAX64 al 6 OK 16iA ve A 1is i�2fF d o/ Contractor's Name R CleV� Telephone Number -0-7/ "4 3 11 Home Improvement Contractor License#(if applicable) �o��op.��.� Email: G Construction Supervisor's License#(if applicable) a 7 0 0 W Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner I have Worker's Compensation Insurance H ,� Insurance Company Name ke Workman's Comp.Policy# 0 Y9/0 ' 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 Replacement Windows/doors/sliderA.U-Value 3 (maximum.35)#of windoC—;3 #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red Sand 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 Ow9er iis sign Property Owner better of Permission. A copy of H Improvement Contractors License&Construction Supervisors License is required. SIGNATURE: T:TME D\Bw7ding Changes\MRKSPaCleMRESS.doc Revised 061313 f HOME IMPROVEMENT CONTRACT PLEASE READ TRW Sold,Famished and Installed by: Branch Name:Boston North&South Rate / THD Al-Humc Services,Inc. d/b/a The Home Depot At-Home Services Branch Number:31 and 33 908 Boston Turnpike,Unit 1,Shrewsbury,MA 01545 Toll.Free 877-903-3768 Federal II7 it 75-2698460;MB.ISc#C 02.439;RI Cont,tick 16427 Cr tic#H1C.0565522:MA Home hnprovement Contractor Reg.#126893 Installation Address: r(e744Q Aoe— tKZA1ki5 d ty State Zip Purchaser(s): Work Phone- Home Phmet Celt Phone: IkIIN5l Rome Ad ess: (1•f different from Installation Address) City State Zip E-muil Address(to receive project communications and Home Depot updates): ❑i DO NOT wish to receive any marketing emails from The home Depot Proiect Information: Undersigned("Customer')_the owners of the property located at the above installation address,agrees to buy, and THD At-Home Services,Inc.('"The Home Depof7 agrees to furnish,deliver and arrange for the installation("Instaltation")of all materials described on the below and on the referenced Spec Sheet(s), all of which are incorporated into this Contract by this reference,along with any applicable State Supplement and Payment Summary attached hereto and any Change Orders(collectively, "Contract"): Job#: aft-W Rd.—) Products S s # Prt-ject Amount ' Roofing Siding Wi=- insulation p $q o ❑Gutters/Cowers❑Envy Doors ❑ U Rxfwg Siding Windows U Insulation oGut /Covers❑Entry boots f"I _ $ ters Roofing Siding ❑windows U Insulation _ $ ❑Clutters/Covers ❑Entry Doom❑ Roofing ElSiding. Rrndows ❑Insulation $ ❑Gumrs/Covers I]Entry Doors Q iuwmum25%depositarCautractAmotmtdoeupmena>t➢onordtieoot+.aal. 'total Contract Amount $ Maine.Punhasers way not deposit more than onelimd of the Contra--Amount Customer agrees that,immediately upon completion of the work for each Product,Customer will execute a Completion Certificate (one for each Product as domed by an individual Spec Shax)and pay any balance due. As applicable,each Customer under this. ..Contract agrixs tv be jointly and severally obligated and liable hereunder. The Home Depot reserves the flght to issue a Change Order or terminate this Contract or any individual Producl(s)included herein,at its discretion,if The Home Deport or its authorized service provider determines that it cannot perform its ubligatiuns due to a structural problem with the home,environmental hazards such as mold,asbestos or lead paint,other safely concerns,pricing errors or because work'required to complete the job was not included in the!!jContract. Payment Summary: The Payment Summary# ��77 ��� included as part of this Contract, sets forth the total ' Contract amount and,paymentx required for the deposits and final payments by Product(as applicable). NOTICE TO CUSTOMER You are entitled to a completely filled-in copy of the Contract at the time you sign. Do not sign a Completion Certificate(note: there Is one Completion Certificate for each lusted Product as defined by individual Spec Sheets)before work on that Product is complete. In the event of terrraination of this Contract,Customer agrees-to pay The Home Depot the cots of materials,tabor,expenses and services provided by The dome Depot or Authorized Service Provider through the date of termination,plus any other amounts set forth in this Agreement or allowed ender applicable law. THE HOME DEPOT MAY WITFIHOLD AMOUNTS OWED TO THE HOME, DEPOT FROM THE DEPOSIT PAYMENT OR OTHER PAYMENTS MADE., WITHOUT LTMPTING'fHE HOME DF.PO'T'S OTHER REMEDIES FOR RECOVERY OF SUCH AMOUNTS. Acceptance and Authorization: Customer agrees and understands that this Agreement is the entire agreement between Customer and The Home Depot with regard ter the Products and installation serviccs and supersedes all prior discussions and agreements,either oral or written,relating to said Products and installation.This Agreement cannot be assigned or amended except by a writing siamed by Custornex and The Home Depot_Customer acknowledges and agrees that Customer has read,understands, ily accepts the terms of and has rec rived a copy of this Agreement. A by: Submi X 6 A, V,9 (1,ft Casio Date Sales Censui is Signatu e / Da SaS"� { Telephone No.� .�j `�q _ Gusto 's Signature -late Sales Consultant License No. CA ELLATION: CUSTOMER MAY CANCEL THIS (as applicable) AGREEMENT WTTEIOUT PENALTY OR OBLIGATION BY DELIVERING WRITTEN NOTICE TO THE HOME DEPOT BY MTilNICHT ON T*W THIRD BUSINESS DAY AFTER SIGNING THIS AGREEMENT, THE STATE SUPPLFMENT ATTACHED HERETO CONTAINS A FORM TO USE tF ONE IS SPECIFICALLY PRESCRIBED BY LAW IN CUSTOMER'S SPATE NOTICE:ADDITIONAL TERMS AND CONDITIONS ARE STATED ON THE REVERSE SIDE AND ARF PART OT TIM CONTRACT 05-14-15 W hfte=Branrh•File .Yellow-Customer Id Wdb0:6 ETOE i£ uef ZZi'ZZ92e0S: 'ON X13A pie6wp[: WONA as t 1"• �y�t� j�t31? � � 2.r-r w+ �`aAa o cup Np, OUR i S s tassdot� a ^rRK� Pt?14e 4O UR oort0 bP E �t�tinA #y�zr£ Cn art 5"aod8tis " 5A k z < spa u ; Ma tr 1 cow 4 fPirau . * CAnm4sswhe v � � as. ���,R�+r��h #'' a �r��,�/��rr+tS�� 'f �/ N // ° fir♦♦�rr��R � a ,, � OtYeaotConsumer.lRaarc R pas�ness Regut�aUoa �y�; 1OMEIIalPROY ENTC0NTRACTOFt {¢ a 4 ; S �q J&J HOME iMFRO�+Eb�£1dj� a a h* W 8R1DGEIMATER Mk 02379 I:inderseeretury <: h"4�"�, �, '6- r s The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Stree4 Suite 100 Boston, MA 02114-2017 a c www mass gov/dia Workers'Compensation Insurance Affidavit:General Businesses. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Le 'bl Business/Organization Name: j 0.S' t! C C!7 J M UjE/ZV7_ Address: 2 SV M xT rtl✓t-b Sr.. City/State/Zip:W .b Rib I F_W4Te%1ef A Phone#: 508--Y31 — 637 / Are you an employer?Check the appropriate box: Business Type(required): 1.❑ I am a employer with employees(full and/ 5. ❑Retail or part-time).* 6. E]Restaurant/Bar/Eating Establishment 2.0 I am a sole proprietor or partnership and have no 7. E]Office and/or Sales(incl.real estate,auto,etc.) employees working for me in any capacity. [No workers'comp.insurance required] g• ❑Non-profit 3.❑ We are a corporation and its officers have exercised 9. ❑Entertainment their right of exemption per c. 152,§1(4),and we have 10.❑Manufacturing no employees. [No workers'comp. insurance required]* 4.❑ We are a non-profit organization,staffed by volunteers, 11.❑Health Care with no employees. [No workers' comp.insurance req.] 12.❑Other 'Arty applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. "If the corporate officers have exempted themselves,but the corporation has other employees,a workers'compensation policy is required and such an organization should check box 41. I am an employer that is providing workers'compensation insurance for my employees Below is the policy information. Insurance Company Name: Insurer's Address: City/State/Zip: Policy#or Self-ins.Lie.# Expiration Date: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification: I do hereby erti ,under t p d penalties of perjury that the information provide above ' true and correct Signature: Date: Z �S Phone#: J�ZS • `— 037 Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Licensing Board 5.Selectmen's Office 6.Other Contact Person: Phone#: www.mass.gov/dia IM' _, C �ine"IJ6 � a�1 rye office of onsum er A ffairs and ss IZegulatlon . 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improver'enf Contractor Registration - Registration: 126893 - Type: Supplement Card THD AT HOME SERVICES, INC. - = - Expiration: 8/3/2016 ANDREW SWEET 2690 CUMBERLAND PARKWAY SUITE=30' 0:` ATLANTA, GA 30339 Update Ad dress dd„ ress d return card-1•I.rl reason r than e_an tuna � -� c as fo_. P c _cai _. 20ra05111 _i Address Renewal Employment rj Lost&rcl &Xe rpoarr,�rzoazcuea�/�o C�j�av ac�cc el/r �i e �—'_Office of Consumer Affairs&Business Regulation License or registration valid for individul use only before the expiration FF OME IMPROVEMENT CONTRACTOR p' tion date. If found.return to: Re istrabonType: Office of Consumer Affairs and Business Regulation 9 12689- Type 10 Park PI - aza Suit 5170 Expiratwn gj3/2016 <. Supplement Card Boston,MA 02116 THD AT HOME SERVICES INC .5 y THE HOME DEPOT AT HOME SERVICES r- ANDREW SWEET` 2690 CUMBERLAND PARKWAY S XT15k A,GA 30339 Undersecretary Nov i with ut signature The Comwnweaft of Hassackwelf Department of lnd=&W As d dexft Offwe of daarves ige&ns 600 Waddngton Beet WWW.H2MMg0V1&0 Workerr s' Compensaden Insmmmce vat:BuffderdContractors/Electricians/Plumbers A_Mh:calnt formation Tease Paint I.es�`bl� Name(Business/Organization/lndividual): f�1►12 c �B111� /GQis Address: q0-9 6 0 5;-410 City/State/Zip: Phone : e ou an employer?Check the appropriate box: Type of project(regni 1. 1 am a employer with + 4. �-•1 am a general contractor and i 6. ❑New construction employees(full and/or part-time).* have hired the sub-contactors 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet.t (�.Remodeling ship and have no employees These sub-cantractors have 8. ❑Demolition working for me in any capacity. workers'comp.insurance. g. ❑Building addition [No workers'comp.insurance 5. ❑ We are a corporation and its rags] officers have exercised their 10.D Electrical repairs or additions 3.® 1 am a homeowner doing all work right of exemption per MGL I L n plumbing repairs or additions myself.(No workers'comp. c.152,§I(4),and we have no 12.❑Roof repairs ftonance required.]t employees.[No workers' 13. Other W1 comp.insurance required.] °A'applima that checks box#1 must also fill out the section below showing their worltete compensation rolicy. t Homemxneas who submit this affidavit indicating they an doing all work and then hue outside conmom mmst sul III t a new of idavit mdicat g such. =Contractors that check this box must attached an additional sly sboamg the name of the sub-counub rs wd their workers'comp.policy hffi mralim. I aeon an employer*at le pr ovh ft aworkem`compemadon wsruwwe,fear my mWloyem Below a t?ae po&y md}ob site Inform t" Insurance company Name: `ems ar'L' $ (�® Policy#or Self-ins-Lic.#: WC, 0 / / 7 3 /V ! 3 Expiration Date: 3 U a O/ �, a Job Site Address: � �'V�• City/State/Zip: &iis 4,otif Attach a copy of the workers'compensation policy declaration pap(showing the policy number and expiration date), Failure to secure coverage as required under section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a - fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP STORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwaaded to the Office of Investigations of the D for ce coverage verification. I do bemby cerg§57 M paw qpdp=aWz ofterjury that dw hafenandon prowNed e#m it pwe and correct, Signature- Date: Phone#: QBIckl we on4k Be not wrke in Ah area,to be completed by city or town offtlral City or Town: Pennit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.CityfTown Cleats 4.Electrical Inspector S.Plumbing inspector 6.father Contact Person: Phone#: ,aco DATE( CERTIFICATE OF LIABILITY INSURANCE WYY) 07115/201512015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT MARSH USA,INC. NAME: TWO ALLIANCE CENTER AIC NNo Ext: FAA/C No): 3560 LENOX ROAD,SUITE 2400 ADDRESS: E-MAIL ATLANTA,GA 30326 INSURERS AFFORDING COVERAGE NAIC# 100492-HomeD-GAW'-15-16 INSURER A:Steadfast Insurance Company 26387 INSURED INSURER B:Zurich American Insurance Co 16535 THD AT-HOME SERVICES,INC. DBA THE HOME DEPOT AT-HOME SERVICES INSURER C:New Hampshire Ins Co 23841 2690 CUMBERLAND PARKWAY,SUITE 300 INSURER D:Illinois National Insurance Company 23817 ATLANTA,GA 30339 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: ATL-003746646-13 REVISION NUMBER:8 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LTR POLICY NUMBER (MMIDDrrrMMM/DD LIMITS A X COMMERCIAL GENERAL LIABILITY GLO4887714-05 03/01/2015 03/01/2016 EACH OCCURRENCE $ 9,000,000 CLAIMS-MADE IJ OCCUR DAMAGE TO RENTED PREMISES Ea occurrence $ 1,000,0W LIMITS OF POLICY XS MED EXP(Any one person) $ EXCLUDED • OF SIR:$1 M PER OCC PERSONAL&ADV INJURY $ 9,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 9,OW ,0W0 X POLICY❑ PRCT O- ❑ JE LOC PRODUCTS-COMP/OP AGG $ 9,000,000 OTHER: $ B AUTOMOBILE LIABILITY BAP 2938863-12 03/01/2015 03/01/2016 (CEO accidentMBINED SINGLE LIMIT $ 1,000,000 X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED SELF INSURED AUTO PHY DMG BODILY INJURY(Per accident $ AUTOS AUTOS ) HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ C WORKERS COMPENSATION WC017731493(AOS) 03/01/2015 03/01/2016 X IPER OTH- AND EMPLOYERS'LIABILITY STATUTE ER C ANY PROPRIETOR/PARTNER/EXECUTIVE YIN WC017731495(AK,KY,NH,NJ,VT) 03/01/2015 03/01/2016 D OFFICER/MEMBER EXCLUDED? a NIA E.L.EACH ACCIDENT $ 1,000,000 (Mandatory in NH) WC017731494(FL) 03/01/2015 03/01/2016 E.L.DISEASE-EA EMPLOYE $ 1,000,000 If yes,describe under a a Conitnued on Additional P DESCRIPTION OF OPERATIONS below 9 E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached it more space Is required) EVIDENCE OF INSURANCE CERTIFICATE HOLDER CANCELLATION THD AT-HOME SERVICES,INC. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE DBA THE HOME DEPOT AT-HOME SERVICES THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 2455 PACES FERRY ROAD ACCORDANCE WITH THE POLICY PROVISIONS. ATLANTA,GA 30339 AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Manashi MukherjeeaCuvot++� �4..�tc�ua ea 01988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD EEO #^� !� ®J http:Jfissg12[hranetfpropdata loolaup.aspx ._ A Eirtg -- ' ���< Edit '�1�4Vr 1✓cl�dDl'IteS- Toolsa.:'�He! :- ��_°` � w, r. "^ak; R�`�' ���' �'#` �'r� b � t� '� ;g "s ,�, '� M r i "4 ,:::�.... . _ ... .�.t— ,' .�,.,.,�,�.,r, ml .-.. d,o,. . ,..�. - ,. .,. ., .a.• .b �::;-.� .�.n..+ `qw ....: < ..,.;�c� 3 �..'xd t-1„'� �'" "�a5 t,. �'" ��^ ,•�,. Fa,uo�fies:; �49eSid Sr%es" .. e?eb9icafler . ... �. y.. .. c a s' � - 3 a- - L �.;:„ r.. b �'. u"�. �` "r -. # s r+;�..`L� a� s, �. � .�(T "d""a� r to � �+, •t, my _,... � � '.;�s `� -. , �:..� ^w.k=: ,« x �•.. �- »gib:*. �' [ .�� ��i®.,.P,a.nr�c eu_l LoauP l.' t' •t s,:.` ._e N!G .^ j,"`a A - .�",.r ?r. .,, .-.<.i, ir,. bx x' iow ,a � r — TSa � k x, � �sk� Mr r 4 ,' Street tree a � �• •Carl Ott �IP�' +�' �C ,�'* �, � ,,xt,'�a" �A2"°• ?e��',-.,. �y,y"' r �'� � �--. •AAA, <Prev N'ext> Page 1 of 1 RGwsfPage-- F0770,Location Owner .. . .- Index . 248-207 68 CARLOTTA AVENUE FRATUS, KATHLEEN G&ROBERT E HY 0249 2482t17 ,� , „�,, ,n '°'auk„ .j:-�x r, "' 'N __..� • F.'s �oCc3�,.A,f1'b'dn�t'. l +� �' r �a.,,�.«, Mart; Mc7ira Systpm Menu-TO..: oApscaUryM� 1 Y�W RP 777N Pa 1p' .l,�'in � y " � ow L{�OM - 1 Town:of Barnstable *Permit#_ Rypires 6 months from issue date Regulatory Services P HAMSTA-BLE yy� 1639. MASS. ' Richard V.Scali,Director AUG 1 pry �A 2 2015 . Building Division Tom Perry,CBO,Building Commissioner TOW OF BARNST 200 Main Street,Hyannis,MA 02601 AB�E www.town.bamstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY 2 Not Valid without Red X--Press Imprint Map/parcel Number �V K . . T , Property Address b r C 414 4 /-1 V u 4417) j - [Residential Value of Work$ � b U Q Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address t/�4 l`�„✓n)n C' �0,UA lQ✓ rn plK) Contractor's Name a� Qr I e SS Telephone Number ,-b Home Improvement Contractor License#(if applicable) 73L Email: ��r4 erf Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance, C�hec ne: Le I am a sole proprietor ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy#, Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to P❑ roof(hurricane nailed)(not stripping., Going'over existing layers of roof) Re-side ❑ Replacement Windows/doors/slide`rs.U-Value (maximum.32)'#of windows` #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with'red S and inspections required. Separate Electrical&Fire Permits required. *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Pro erty Owner must sign Property Owner Letter of Permission... A opy of the Home Improvement Contractors License&Construction Supervisors License is r uire . SIGNATURE: Q:\WPHLESTORMS\building permit orms\EXPRESS.doc' Revised 040215 771e Comrtrorrfrealth of Massachusetts Departrrrertt of rndustrial Accidents - - r fI,f,�ce of Imw—stigations 600 Washington Street r ti Boston,MA 0211I mvn:mas&gov1dia '"Torkers' Campensatian Insurance Affidavit Builders/ContractGrs/Electririans/Plumbers Applicant Infannatian Please Print Lelzib � Iy Name(B»SssMiganizationadivldnal} �c /f o 1, u r r f U A.d&ess: C/9 l"l J n �T V ►I/11 J h - j I j � 0 Citylstatt~lzig- Phone Y�- S' _ F-a FT _a a 3 Y Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I)d!6 a employer urith 4 ❑I am a general contractor and I 6. ❑New construction loyeea(full and/or part-time).* have hired the sub-contractors 2. I am a sole proprietor or partner listed on the attached sheet 1_ ❑ oaeliug slip and have no employees. These stab-contractors have 8. ❑Demolition w Q for me in an c employees and have workers' ` �b y �1t3`- 9. ❑Building addition', jldo workers'comp.insurance comp-insurance l required-] 5. ❑ We area corporation and its 14❑Electrical repairs or additions 3.❑ 1 am.a homeoum-er doing all work officers have exercised their 11_❑Plumbingrepaiis or•additiom myself o workers' right of exemption per MGL �1' � - 12.El Roof repairs. insurance required-]1 � C.132, §I(4h and we have no / employees.[No workers' 13.❑Other ire S i�e comp.insurance required.] - 'AayWBca mat checks lox Almmstalsoflloutthe section below sbuuing their tuodere compensation policy iaformatio - Mmeovime s who submit this affidaxrd indicating they are&ing all weak and dhrm hire outside contractors—ct submit a new affidavit indicating sack. fCantractors that check This boa mast attached au sdditiaad sheet shooing the name of the sub-conarwAmm and state whether or not those sidles bane employees. 7fthesab-contractnrsluveenptoyeas,they must pmv-idetheir workers'-camp.policy number. .Tam an ersp2 r thatis protzdiri n�orIsers'coirrperisafiirit iiisziratzce, or a�i}*entpIay�ee� Below is rlte policy and job sztrr informadon. Insurance Company Nam- Po licy 4,:F or Self-ins-Lic.9: F Tiration Date: Job Site Addrew: CitylState/Z,p: Attach a copy of the workers'compensationpolicy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c 152 can lead to the imposition of criminal penalties of a fine up to SUM 00 andt'or one-year imprisonment,as well as ci-0 penalties.in lire farm of a STOP WORK ORDER and a fime of up to MO-00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the D for insurance coverage verification. I d'o hereby cerfifj,ui er frig is acid prnab{res ofpeg'm y that Ste infonnatioi>pm.-ided aboi a fs true and carrect Sitmature Bate_ Phone 4- 6 07 S a J p Official use only. Do not iwiite in th&.area,fo be cotnple-W by city ortown o fcEaL . City or Town.: PermitUcense if Issuing Author€ty(circle one): 1.hoard of Health 2.Building Department 3.Cityffown Clerk d.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 recces all employers to provide workers'compensation for their employees. PvrsumA-to this statute,aa.eaplayrr is defined as."_.evmy person in the service of another under auy contract of hire, express or implied,oral or wrhm�" An employe-is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the rT in=ga a joint entmprisa,and including the legal represeniaiives of a deceased employer,or the receiver or trnstee 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 maim a an cB,construction or repair woik on such dwelling house or oa the grounds or building appTrtcu=t thereto shall not because of such employment be deemed to be an employer." MGL chaptnr 152,§25C(6)also sites that"every state or local Hcensmg 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,MOIL chapter'152, §25C(7)states"Neither the commonwealth nor dny of its political subdivisions shall enter into any contract for the p mfounaam ofpublic work until acceptable evidence of compliance with the in dean ce.. requirements of this chapter have been presented to the cadract ing author" ' Applicasits , Please fill,o�c± the woikers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s), address(es)and phone number(s)along with their certfficate(s)of msuTance. Limited Liability Companies(LLC)or Limited LiabilityPartaerships(LLP)withno employees other than the. members or partners,are not required to cant'workers' compensafion insurance. If an LLC or LLP does have employees, a policy is req-eired. B e advised that this affidayit maybe submitted to the Department of Industrial Accidents for conffimation of insurance coverage. Also he sure to sign and date-he affidavit The affidavit should be ret=(-_d to the city or town that the application for the permit or license is being requested,not the Department of Tnrhictrial Accidents. should you have any questions regarding the law or ifyou are required to obtain a workers' compensation policy,please call the Department at the number listed below, self-insured companies should enter their self-h suza +ce license number on the appropriate line. City or Town Officials . t Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affida-vit for you to fill out in the event the Office of Investigations has to contact you regmrding the applicant Please be sure to fill in the penmit/license number which will be used as a reference number. In addition, an applicant that must submit multiple pmnit/license applications in any given year,need only submit one affidavit indicating cmreat policy in�=ation Cif necessary)and under"Job Site Address"the applicant should write"all locations in (sty or __ h e or tovm may be provided to the e� da ' that:has been officially ed or marked b the city y town)_ A copy ofih affi nit y stamp by ermits or licenses_ A new affidavit must be filled out each -proof that a valid affidavit is on fit for furore applicant as pr f P _ _ entvre not Zatrsi t0 all business Or commercial Y year.Where a home owner or citizen is obtaining a license or permit n re y (i e. a dog license or permit to bum leaves etc.)said person is NOT regshed to complete this affidavit ike to than you i�a adv�mce for your cooperation and should you have any questions, The Office of Investigations would l please do not hesitate to give us a caIL The Department's address,telephone and fax number. Tht C:G.mMmWatth of Mass-aohuszatts Departneat of Iiadimfrial Accidents Gface 0f 1AVe&dgatiw1,% (504,VlasbiVo;u t Bostau, I4I1F T(�L 4 617. 27-49-00 Qxt 4€6 or I--9 -M -SSAFE Fax 9 6l7-`27 7M ww Revised 4-24-07 rr,a �_gavld[a. +' BARNSRABLE, 9�A1 �,�� Town of Barnstable FD WIA't Regulatory Services Richard V.Scali,Director Building Division Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us. Office:'508-862-4038 Fax: 5.08-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder as Owner of the subject property hereby authorize S (l A 0l4 e 0 to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address offob) 01 Signa e of Owner Date kA-4 mill Aix)- Print Name _ If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. Q:\WPFILES\FORMS\building permit formsMPRESS.doc Revised 040215 Town of Barnstable �a Regulatory Services �oFT rOry,` Richard V. Scali,Director , Building Division saxxszwa Tom Perry;Building Commissioner MASS. 1639. ��� 200 Main Street, Hyannis,MA 02601 prEn � www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print . DATE: JOB LOCATION: number street village "HOMEOWNER": name home phone# work phone# . CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-ocMied 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 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. 1 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:\WPFILES\FORMS\building permit forms\EXPRESS.doc Revised 040215 Vhe W,o' c 'iealch a�C ao�ivaeCta. )<.i nse or re istration valid for indrvidul use only. - ice Of of Consumer Affairs&Business Regafition qq g M IM.PROVEMENT CONTRACTOR f bgfore.the expiration date. If found return to: ,egistration 1224�g Type:. Office of Consumer Affairs and Business Regulation xpiration:,-913/2Q1:6; DBA 10 Park Plaza-Suite 5.170 `Boston,MA 02116 . SCOTT BURGESS SSCOTT BURGESS. 492 FRONT ST. CIUEYMOUTH,MA 02188 Undersecretary Not valid without s,gnature ---• ` Rfstricted To CSSL RF-Roofing CSSL-WS-Windows and Siding a f Foilure to possess a turrenf edrt{on of the Massachusetts 1 t f $Late Building Cod e{s cause foi�revocat{on.o�thislicense...::` For DPS Licensing{nformat�ori ws{t www Mass Gov(DFS 1� h , rw­ 5 lvla sachpsefts;Department of.Public Safe�. B'oard,of Bpilding,RegUla#ions and Standards' sf ConstrUchon Superfisor'Speci 1, License. CSSL-100919 ee � ;;SCOT.T E BURGESS 492 FRONT STREET�9 . WEYMOUTH MA 02188; ` v ob ' Commissioner 16/2M2015 ;' 1 t� XmPREsS PERMIT AY - 4 2007 Town of Barnstable *Permit# 0 77S „y� 1 Expires 6 months from issue date SARSTSegulatory Services Fee �S snaxsras MAss. Thomas F.Geiler,Director ib;y. F1�t° Building Division Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.bamstable.ma us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number � �G7 Property Address OL/ ( Zesidential Value of Work 5q30, 0 Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address c- /t Contractor's Name _'.Aot.ALA, y Telephone Number 50 a I? _a aZ 4 Q. Home Improvement Contractor License#(if applicable) 1 °+� 5 3 65-�' Construction Supervisor's License#(if applicable) ZWorkman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner I have Worker's Compensation Insurance Insurance Company Name U -co Workman's Comp.Policy# („ i Q 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 t ❑Re-roof(not stripping. Going over existing layers of roof) ❑ 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: ro Ownqunust sign weer Letter of Permission. Home ense is required. SIGNAT RE: Q:Forms:expmtrg Revise071405 t� CNN The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 . s• www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): T/(aA_Q_� Address: CD I gqc; City/State/Zip: WC- O 9,635 Phone#: Are you an employer?Check the appropriate box: Type of project(required): employer with 1.En am a 4. ❑ I am a general contractor and I � * have hired the sub-contractors 6. ❑New construction - employees(full and/or part-time). 2.❑ I am a sole proprietor or partner- listed on the attached sheet. # ❑Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. 9. ❑ Building addition [No workers' comp.insurance 5. ❑.We area corporation and its officers have exercised their 10.❑ Electrical repairs or additions required.] 3.❑ I am a homeowner doing all work right of exemption per MGL I L E]Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4),and we have no 12.❑Roof repairs insurance required.]t employees. [No workers' 131-1 Other comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. #Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:T Policy#or Self-ins.Li''c.#: 7 I `T /v 6 t q Expiration Date: Job Site Address:. a 'tQ_ -City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy numb and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do herebrxBraALuuder t s and attics o per ry that the information provided above is true and correct. Signature: Date: J — / Phone#: ����`7y��o` Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Bo ard of Building Regulations and Standards One Ashburton Place - Room 1301 Boston, Massachusetts 02108 Home Improvement',Cortractor Registration Registration: 112536 Type: DBA FRASER CONSTRUCTION CO. Expiration: 3/23/2009 Tr# 127920 DEAN FRASER P.O. BOX 1845 COTUIT, MA 02635 Update Address and return card.Mark reason for change. DPS-CA1 Co soon-osios-Pceaso - Address Renewal ❑ Employment Lost Card fie '�o7noszoozcuea�,� o�✓�aaar.�ivaeti✓'a - Board of Building Regulations and Standards License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration: 112536 Board of Building Regulations and Standards Expiration: 3/23/2009 Tr# 127920 One Ashburton Place Rm 1301 Type: DB74i Boston,Ma.02108 FRASER CONSTRUCTION CO.x DEAN FRASER 4556 RT 28 COTUIT, MA 02635 Administrator Not valid without signature No. 158h ?. 2 LSStTD.ATE rMASANT TDITS CERTIFICATE IS I ISUBDAS A MATTER ON INFOAND CONPPRS NO AANUT10N ONLY I'GHCUTTVICATEAOESR TTANIEND,RXTk DOR'JPON THE C HOLDER. THIS ALTB'dtT'IDi OVERAGE WSUl2ANCE AGENC4'' AFFORDED By TIIB P�oLxcrizs grLOiv ST A 02301 COMPAle WS A+fi FOal1VC CoVgRAGg C�OJT A,.full 012D YJNDERt�'RIT$12S COAQANY' DVS CO InrsC'o1sD L27TB12 B FRASE R CoNSTR U'CTION C PO BOX 1845 COTW.MA 02635 ' COMPANY LIrMt THIS IS TO CEa:M.,INAT DO POLICI88 OF D,'SURAIVCE LISTED BEIOW HA r N - INDICATED,NOTMT.Y9YnNDWO ANY �'::: vii 8EF"'U6D'I�p TfM IN URED-N-AM SD A:GO UR FOR INE PO1ICY P5RIpb QUIREMBNT,TERM OR CONDITION OF ANY CONTRACT OR OTHIIR DOC[Aof6td7 tVllti Rp$pgcy Tp;vf RCII THIS CND C0ND171 N BB lS54)En OR M qY PERTAIN;TIIB)iJ8UR.4NCd•API.=M RY THS POLICIES DE.WG MFZ I l7Rt 1 IS SU9J13CT TO ALL T O TERMS, CLUSIONS AND CONDITIONS OF SgC}TPOLICffiS L g SIIp} MAY g REDUCED BY PAIN CLAIMB CO TYPE OF INSURANCE LTA POLICYNUMRER POLICY POLICY EFPS;CTIYl3 BATE EXPIRATION DATE LIMITS CrBNERAT,LTAHTLITY (MM/DDfYY .. CDMbMCLAL G$NEBAL LIAHILIT•Y - - OBA'ERALA TH aAM MOB 0 g CCU$ 5-CDMWOPAOO. $ OWAus&CMVMACTM1;$PROT. PERSONAL&ADP.JWXMY $ - BACHOCC \CB $ AUTOM04ILE LTAEILITV h DA\tAGB ll One $ MBD.WANS8(A,q•ovePam $ u+YAUTO COMBEI6DSINOLPL $ ALL OWNPD AUTOB SOMDULBDAUTOS BOOM DAUTOS ft P-1m) NOM.OWA'pDAUTg3 ' BODILY Logy $- OARAOBL7ANUTY _ (PerAcCreoO AER7^(DAMA $ . LXC938 WADIL]i Y Gp UMBPRLLA FOAM . . OTNBB T}us1 SLfAFORMA OCCURR8NC8 AUMMOATE A w'ORRER S COMMNSATION stAIYTfOtsY Lnwrrs AND EMPL 6,S60LM494X6f9; r CN EAACDmB S]00,000 O4 sLLLBILTTy �79/26,06 OTH)3Tr 09/26!07 DISPAS>r B:G Po CYLT S5Co,Ooa DISBASB EACB ' �� SlCO,00D DESC&fp'ITONOFOPERAYYON'9lT.00ATiONSIVErICCLF�rSPECL►L ti�f9 1 THISR>'PtACES ANY PoloA rrD tFICiiTB tSSU1CB CEATI1��y�,HOLDEI2. TBa CSRTIFfcAT>aHOLOER AFBscrnv�H'0117SER8 confr ca CANCELLA!'1O(.J FRASLR tONSTRU&XON SB uwASYOFTBB Am1k n70.q.'' prauc, BncAncsLLPbR' :: PO BOX1946 LXF3RAr=AATETBBR80B,TIMI&$ cCDM7ANYCANcWMLPPuBAVOR III:T8E CO'�IMI'T, WRrI 7eN NOUO2 TO T&CERTnWATE 7TOLbBR NASfHIy 'O hlAu Io OZ6d5 0UTFAELuU TO MAIL SUC•y NOPICE SgALX IMPos>NO OAAOMTWN m Lvrr. LkBflm OR ANY no tYON TIM COb1P,IAIY, M AGOTA OR B1IPR6S>i\TATrygq AL GAB9SHTAYfNi �ypy ' ••�AC012b•tC�R7�wRi►TIOIV 89;�0 Fraser Construction Roofing & Siding Specialists P.O. Box 1845, Cotuit MA. 02635 Email: fraser_construction@verizon.net www.fraseiToofing.com Phone 1-508-428-2292 & FAX 1-508-428-0123 RE-ROOFING PROPOSAL "REVISED April 20, 2007 (6% increase in prices from the original proposal)" DATE: April 28, 2006 Name: Bob and Kay Fratus Phone: Day (617)770-4851 Evening (508)778-9709 -Job Address: 68 Carlotta Ave Hyannis, Ma. 02601 Mailing Address: 16 Hobomack Rd. Quincy;MA 02169 t FRASER CONSTRUCTION herby proposes to perform the following services in neat and professional like manner and in accordance with the manufacturer's specifications and local building codes. -Remove and haul away all of the old Asphalt Shingles -Re-nail all plywood sheathing as needed Supply and Install CERTAINTEED XT AR-30:30-YEAR WARRANTY, 5 YEAR SURE START PROTECTION, CLASS A FIRE RATED, ALGAE RESISTANT, EXTRA HEAVY WEIGHT, SELF- SEALING, Multi-Layered 3-TAB, FIBERGLASS BASED ASPHALT Shingle with New England' Exclusive COPPER/CERAMIC STONES with a FULL 10-YEAR WARRANTY AGAINST ALGAE CONTAMINENT. COLOR: Supply and Install CERTAINTEED LANDMARK AR-30:30-YEAR WARRANTY, 5 YEAR SURE START PROTECTION, CLASS A FIRE RATED, ALGAE RESISTANT, EXTRA HEAVY WEIGHT, SELF- SEALING, Multi-Layered 3-TAB, FIBERGLASS BASED ASPHALT Shingle with New England' Exclusive COPPER/CERAMIC STONES with a Full 10-YEAR WARRANTY AGAINST ALGAE CONTAMINENT. . COLOR: 1 - F/7 Fraser Constru" ction ~ Roofing & Siding Specialists 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$50.00 per hour, plus materials, plus 20% overhead mark-up on total extras. FRASER CONSTRUCTION Warranties the labor for 12 years FRASER CONSTRUCTION Warranties the shingles against Blow-Offs for 10 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. ` 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: Carries Workman's Compensation and Public Liability Insurance on the above work, certificate available upon request. DATE OF ACCEPTANCE: O� 7 ; H meowner Fraser ons uction 3 Z_ 40 MtU (o K 8 1 r ' ►-�.�'P,q- ( j IOv U taxP. to tom, C.A.L. MIAJ o � WILLIAM i CEQTIr-IED PLC>-T- L OC.A►T 1 O" WEST H Y�N N N t S 1 Cr.IZTI4=14 T►4AT' Thies FWVJ6A"n0IJ 5Uawt.1 t-at_Q Ecsc,1 GtaNlPt_�(S W t TN TWG L G "'►' t � A.1�i.7 SETBACK {ZEQUIiZ6N�c�1TS OF TN{~ W—er= t,. C-. _ _ E G I S 1�C.i'LTib LA W CO S U Q V a"s Yu v% T"tS C7L.At-1 IS LlUT BASEa va~► A�.1 v S't'6R.V 16.t..G %*4,5 leEJAAEt4T SveVG•( THE U��Si"c�S SNdait:o Apia trt G/S.ti1T' t,JoT 66 USeC> To DeeTEZMVW& 14>-T LIW-.S �`;.> 4 t As so_r's,map and lot. number ...M.�. ..... ,.�. € 1'(C _ SYSLED TEM MUS-' 3� Sewage Permit number ........................................................... 3AN C �► STA (rA�Y rE " E � 'T� CODE AN W j D T® Pyo�t"ET°� c TOWN OF BARNSTA LE 03 9 ` NU.ILDING INSPECTOR . OD �7i639:•\0� MPY a' APPLICATION" FOR PERMIT -TO Ir1 y� �/ ...... `........- °... .`Y ...................... ............................. TYPE OF CONSTRUCTION ....W..V.G.11.i.70....F4AA4.E ......nil.?9�tI^l........................................................ ',ea. ........./.........19. ..� TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according'to the following information: LocationO. T. ..1............ �f^. �1 .......�y�! ...........wg_ r................. V [.. .............................. ProposedUse ......7' `"21. ..........Diti' '! l i` .G-"................................................ ....................................................... Zoning District Fire District .............................................. ........................... Name of Owner �0�3. !L,7-, '..... ©.�S`f- Address ..�` f3 wS T�1� L /��J ..J .. ..... ............... ..................... ............... ........................................ Nameof Builder ..................'..................................:...............Address ...................................................................�................ Nameof Architect ..................................................................Address .................................:.................................................... .� 1 .! V. P-S.........................Foundation ...... 4 1 n............�.f�wc, ATE Number of Rooms ...6.. ... / Exterior ....7- ...... .........C-4r d!..09#x P...........Roofing' .....A./At? ....... .........0.................. Floors .....�74,. ...................................... O C ........�V ...Interior ....�.��� T....�.........+�...................p...................... Heating ... ?.1:. -,...........hl .-17......1!"..�'�"/�!�...............Plumbing ...�..-al—de 7:04'......�? z-.s......../...�.�........... Fireplace ........ E. ,�^ �/..�..s.............................................................Approximate Cost�.��.7..t.... ..(j...C)......................... Definitive Plan Approvedby Planning Board ________________________________19________. Area .... .�l� ........` ` Od Diagram of Lot and Building with Dimensions Fee ...... 1...: ................... SUBJECT TO APPROVAL OF BOARD OF. HEALTH i� teo, ' 1' O l E ; LI vpIV&, f I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name .U.. ...?`................................. Sousa, Robert A. ' 19126 one story\ ............. Permit.,for ........................... lingle family'dwelling ........................................................................... Carlott,a Avenue, Location ...........................................I............. Hyannis ......................................................................... Robert A. Sousa Owner ....................... ........................................... frame'- Type of Construction .. ................. .................................... ........................f�................... Plot ............................ Lot ..........#4.1............... • 77 .................... -Permit Granted ... April 20r. ....... 19 ........ 19 Date of Inspection Date Completed ... W ................19�6 PERMIT-REFUSED ........................ ......................................... 19 ........................................................I.............. ....... ............................................................I....'....... ............................................................................... ............................................................................... Approved ................................................. 19 ............................................................................... ............................................................................... 06, Assessor's map and lot number ....�. .........,....:..........f... .., r. Ie Sewage Permit number .......................................................... w °`T"E�°� TOWN OF B�•ARNSTABLE Z 33ANSTAME, i 9� O 39- BUILDING INSPECTOR f i APPLICATION FOR PERMIT .TO ........................... ........-:?..o.v..:............................................................. ' TYPE OF CONSTRUCTION ... illl1 I ..„ra {✓Tart c-.........................:..................... .:........... .........19.1) TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: d ` Location A. .. .......... 21 d 7 "Y ......... wf6 ......... �T .....:........................ ......................i ... ProposedUse ... . ...........L...Ec,4-:1..!.. ..`.r::"::.......................................................................................................... ,. Zoning District ........................................................................Fire District ..../.1/,-/,• N+�r 4 Name of Owner !�. ✓ f2. .. .... d.c/ /t�...........:......Address .�:..... ! rVV - / .....'. ...... Nameof Builder ....................................................................Address..................................................................................... Nameof Architect ..................................................................Address .................................................................................... Number of Rooms ..(r....... .........................Foundation .9r? 1-.L .../.. ....................................... Exterior //� r 1 n , Nam '!?. ........Roofing / F�AS v�T ........................................ . ... . , ........... . f« ....... f�. ..:........................................Interior ....� Aj!�e 7- Floors ....!�1 U C .. .e........... ...... ...................................................... ..!'?../. t / , r..... •!'� / _..............Plumbin �...�...x��' rfl .... U art��/.. ........ ....:...Heating ........... g ...... Fireplace ....... Approximate Cost��.: ...................................... . .. ...... , . . Definitive Plan Approved by Planning Board _______________________________19________ . Area .....,..................... Diagram of Lot and Building with Dimensions Fee �..�'�l "— ................................. SUBJECT TO APPROVAL OF BOARD OF HEALTH O *T Y- x� �c= '� E.D D�U kn �U / a I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name . ..................................,;............................................ Sousa, Robert A. A=248-207 , ' 19I26 one story' No ................. Permit for --.----..�----. - - _ ^ . ^ - � single family 6vwmll1oa ' ''~-------'--^---'/—'---'—'---~' Carlotta Ave. _ Locpnon(Dvm—''�----------------'' ' Hyannis ' .----.---------------.-----.. �-�-- - ' ^ �w�rt A. Sousa . Owner _-------_,____________ , . � . frame Type of Construction ...................................n..... . . . ----.---..-----------------.. ~ ~ ' ^ ; Plot --..------.. Lot ---'��l----' ' - Perm kGranted .................................�l2� --.lV 77 Dote of Inspection ------------l9 uota Completed 19 . PERMIT REFUSE ~ ' ' . ^ lA . ----. _ �� ........................................... . . . . _ .......................................... .................................. ' . ................................................ .............................. , . ' . - _-------.. ---- . q . Approved �r��� . = -------.---------..-----.--�. ` _ -------'------- ....... - / ' ^ '