HomeMy WebLinkAbout0056 COUNTY SEAT STREET 1 J
��
._- t
J
Q-1.
r,
Town of BarnstableBuildifig
Post This Card So That At is;Visible From the Street Approved:Plans`Must be Retained-on"Job arid'this Card"Must be Kept
6A g Posted UntiitFlnal Inspection Has.Been Made Permit
Where a Certificate of Occupancy is Required,such Building shall Not b' Occupied until a Final`Inspection has been.made \
�. .. w, h _ . . . �..
Permit No. B-19-4205 Applicant Name: BILIK, ROSEANA Approvals
Date Issued: 12/19/2019 Current Use: Structure
Permit Type: Building-Siding/Windows/Roof/Doors Expiration Date: 06/19/2020 Foundation:
Location: 56 COUNTY SEAT STREET, HYANNIS Map/Lot: 291-110 Zoning District: RB Sheathing:
Owner on Record: BILIK, ROSEANA Contractor Name:, Framing: 1
Address: 152 CAMMETT WAY Contractor License 2
MARSTONS MILLS, MA 02648 Est.,Project Cost: $ 1,000.00 Chimney:
Description: replacing.2 windows x Permit,Fee: $35.00
.Fee Paidc.4. $35.00 Insulation:
Project Review Req:
" Date 12/19/2019 Final:
511
,,
Building Official
Plumbing/Gas
This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six;months after issuance.This
Plumbing:
All work authorized by this permit shall conform to the approved application'',nd the approved construction-documents:for whieh�this permit has been granted. Final Plumbing:
All construction,alterations and changes of use of any building and structures shall be in compliance with the local'zoning by laws and codes.
This permit shall be displayed in a location clearly visible from access street or;road and shall be maintained open for public inspection for the entire duration of the Rough Gas:
k
work until the completion of the same.
14
Final Gas:
The Certificate of Occupancy will not be issued until all applicable signatures by the Building and fire Officials are provided on this permit.
Minimum of Five Call Inspections Required for All Construction Work: B *t
Electrical
1.Foundation or Footing $
2.Sheathing Inspection ° a Service:
11
3.All Fireplaces must be inspected at the throat level before firest flue lining is installed
4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection ; ' F Rough:
5.Prior to Covering Structural Members(Frame Inspection)
'"
6.Insulation Final:
7.Final Inspection before Occupancy
Low Voltage Rough:
Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations.
Work shall not proceed until the Inspector has approved the various stages of construction. Low Voltage Final:
"Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Health
Building plans are to be available on site Final:
All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Fire Department
Final:
Q-o/
xr
{ Application number �070..5
p�NG DEpT - � Fee . .�.J�.../..................
.....�................................
L DEC 9 WAS& 20�� Building Inspectors Initials........ ::.
wN OF SgRftSTABLE Date Issued...............�..Z.�.!.1..�..�..°�,.......................
Map/Parcel.............:...a... . ..................
-TOWN OF BARNSTABLE
EXPEDITED PERMIT APPLICATION:
ROOF/SIDING/WINDOWS/DOORS/TENTS/STOVES/WEATHERIZATION
PROPERTY INFORMATION
, Address of Project: 4:Z )A1--y ,—Y--A- ' �J u,'S -
NUMBER STREET VILLAGE
Owner's Name: 'AJJ A /Eil I- Phone Number SQg 360 518
r ,
Email Address: Number 51 ,91
Project cost$ Iwo 0, Check one Residential Commercial
OWNER'S AUTHORIZATION
As owner of the above property I hereby authorize
to make application for a building permit in accordance with 780 CMR
Owner Signature: Date:
TYPE OF WORK
0 Siding Windows (no header change)# .a 0 Insulation/Weatherization
0 Doors(no header change)# Commercial Doors require an inspector's review
Q Roof(not applying more than 1 layer of shingles)
Construction Debris will be going to
CONTRACTOR'S INFORMATION
Contractor's name
Home Improvement Contractors Registration(if applicable)# (attach copy),
Construction Supervisor's License# (attach copy)
Email of Contractor Phone number
ALL PROPERTIES THAT HAVE STRUCTURES OVER 75 YEARS OLD OR IF THE SUBJECT PROPERTY IS IN
A HISTORIC DISTRICT. YOU MUST OBTAIN HISTORIC APPROVAL BEFORE A PERMIT CAN BE ISSUED.
APPLICATION NUMBER............................................................
t
*For Tents Only* t
Date Tent(s)will be erected Removed on number of tents total
Does the tent have sides? Yes No (If yes please attach floor plan with exits marked)
Dimensions of each Tent X X X
Additional tent dimensions can be attached on a separate piece of paper.
Purpose of Event
Check one: this event is a: for profit non-profit event
Check one: Food served Yes No
Flame Spread Sheet of each tent must be attached. Provide a site plan with the location(s)of each tent
Fuel source being used LP tank 20 lbs. or> Yes No , if yes, a gas permit is required.
Natural Gas Yes No 1 if yes, a gas permit is required.
Iffood is being served at.your eventplease obtain a Health Department approval between the hours
of 8:00am-9:30 am or 3:30 pm-4:30pm. Commercial events may require Fire Department approval.
*WOOD/COAL/PELLET STOVES
Manufacturer# Model/I.D.
Fuel Type Testing Lab
Offsets from combustibles: front bask left side right side
HOMEOWNER'S LICENSE EXEMPTION
Homeowner's Name:
Telephone Number SCO &0 S/8/ Cell or Work number SC8 S/
I understand my responsibilities under the rules and regulations for Licensed Construction
Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand
the construction ins ction procedures, specific inspections and documentation required by 780
CMR and of . arnstable.
Signature Date 121 1 g 19
APPLICANT'S SIGNATURE
Signature Date
All permit applications are subject to a building official's approval prior to issuance.
4 j The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston,MA 02111
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name(Business/Organizaton/Individual):/e cAIUA 1 r�,
Address:,,-,
City/State/Zip: P 'S .'1 ,A 096YLoPhone#: 508 3605181
Are you an employer?C eck the appropriate box: Type of project(required):
1.❑ I am a employer with 4. ❑ I am a general contractor and I
employees(full and/or part-time).* have hired the sub-contractors 6. [3 New construction
2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7.,.❑ Remodeling
ship and have no employees These sub-contractors have g, ❑Demolition
workingfor in an capacity. employees and have workers'
Y P h' 9. ❑Building addition
[No workers'comp.insurance comp. msurance.x
required.] .5. ❑ We are a corporation and its 10.❑Electrical repairs or additions
3.Q 1 am a homeowner doing all. . officers have exercised their I LE]Plumbing repairs or,additions
myself. [No workers'comp. right of exemption per MGL 12.❑Roof repairs
insurance required.]t c. 152, §1(4),and we have no
employees. [No workers' 13.❑ Other
comp. insurance required.]
*Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
$Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have
employees. If the sub-contractors have employees,they must provide their workers'comp.policy number.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name:
Policy#or Self-ins.Lic.#: Expiration Date:
Job Site Address: City/State/Zip:
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGL 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 maybe forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby e the pains and penalties of perjury that the information provided above is true and correct
Si Trt_
ature: Date: �9 I
fV
Phone#: - -- — --- --
Official use only. Do not write in this area,to be completed by city or town official
City or Town: Permit/License#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
w
Information and Instructions
l
Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. '
Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire,
express or implied,oral or written."
An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more
of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the
receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the
owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the
dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house
or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer."
MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or
renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any
applicant who has not produced acceptable evidence of compliance with the insurance coverage required."
Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall
enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance
requirements of this chapter have been presented to the contracting authority."
Applicants
Please fill out the workers'. compensation affidavit completely,by checking the boxes that apply to your situation and,if
necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of
insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the
members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have
employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial
Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should
be returned to the city or town that the application for the permit or license is being requested,not the Department of
Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers'
compensation policy,please call the Department at the number listed below. Self-insured companies should enter their
self-insurance license number on the appropriate line.
City or Town Officials
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom
of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant.
Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant
that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current
policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in_(city P P or
town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the
applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each
year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture
(i.e.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit.
The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions,
please do not hesitate to give us a call.
The Department's address,telephone and fax number:
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of investigations
600 Washington.Street
Boston,MA 02111
Tel.#617-727-4900 ext 406 or 1-877-MASSAFE
Revised 4-24-07 Fax#617-727-7749
www.mass.gov/dia
d Town of Barnstable *Permit# �� 101�S70
THE
04 Tp� hi
y,VP� 0 YV Expires 6 months from issue date
�. Regulatory Services Fee
BARNMELE,
v MAC' Thomas F. Geiler, Director
lED MA't 6 ZOOg
TON OF g Building Division
ARIV,S)AB�ETom Perry,CBO, Building Commissioner
200 Main Street,Hyannis, MA 02601
www.town.barnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY
Not Valid without Red X-Press Imprint
k1ap/parcel Number 1 ` 0
Property Address_ COO&) � O�'� �_A `Au r� �j
o c>
Residential Value of Wort. `�j7 Minimum fee of$25.00 for work under$6000.00
Owner's Name& Address �� �Q R1()C� \
Contractor's Name C ~� Telephone Number
1 Ionic Improvement Contractor License# (if applicable)
Construction Supervisor's License# (if applicable) CS
❑Workman's Corn nsation Insurance
Chec ne:
I am a sole proprietor
❑ 1 am the Homeowner
❑ I have Worker's Compensation Insurance
Insurance Company Name �2CA > �)� S(�LtftoC,9—. -
Workman's Comp. Policy #
Copy of Insurance Compliance Certificate must be on file.
Permit Request(check box)
dRe-roof(stripping old shingles) All construction debris will be taken to 8dOa4jzf, L4 tJ- F(
❑ Re-roof(not stripping. Going over existing layers of roof)
��Re-side
Replacement Windows/doors/sliders. U-Value .6 (maximum .44)
*Where required:- Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc.
'Note: Property Owner must sign Property.Owner Letter of Permission.
A copy of the Home ovement Contractors License is required.
SIGNATUR
).`N`I'I-II.I:S\I:ORMS\building permit forms\EXPRESS.doc
Revised 100608
F
~ The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston,MA 02111
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Le 'bl
Na]Me(Business/Organization/Individual): l
Address: ci's
City/Ste'Z'
p: Phone.#:
Are y employer?Check the r to box: Type of project(required):
1. I e 4 ❑ I am a general contractor and I 6. ❑New construction
e ployees(full and/or part-time , have hired the s'ub-contractors
2:[ I am a sole prpprietor or partner-' listed on the attached sheet 7• .Q Remodeling
• ship and have no employees These sub-contractors have g_'❑Demolition
employees and have workers'
working for me in any capacity. $ 9. ❑Building addition
[No workers',comp.-insurance comp. insurance.
10.❑E ectrical repairs or additions
required.]
5. ❑ We are a corporation and its
3.❑ I am a homeowner doing all work officers have exercised their I LE] lambing repairs or additions
myself.[No workers' comp_ right 6f exemption per MGL 12. Roof repairs
insurance required.]t c. 152,§1(4),and we have no 13.0 Other
employees. [No workers'
comp.insurance required_]
'Any applicant that checks box#i must also fill out the section below showing their workers'compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
tContractors that check this box must attached an additional sheet showing the name of the sub•Contractms and state whether or not those entities have
employees. If the sub-contractors have amployacs,they must provide their workers'comp•policy number.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name:
Policy#or Self-ins.Lic.M Expiration Date:
Job Site Address: City/State/zip: '
Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date).
Failure fo secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of erimirial penalties of a
finq dp 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
Investi ations of the DIA for insurance coves a verification.
Ida hereby ce uj1h e ' s d p ti f perjury that the information provided ove is true a�co?-re�.cl
Si e• - Date: —
Phone#
Official use only. Do not write in this area,to be completed by city or town'offuaaL
City or Town: Permit/License#
Issuing Authority(circle one):
1.Board of Health I.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.PIumbing Inspector
6.Other
Contact Person: Phone#:
• f
Information and Instructions r w
Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees.
Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire,
express or implied,oral or written."
An employer is defined as"an individual,partnership,association, corporation or other legal entity, or any two or more
of the foregoing engag in a�am en rpnse-in-lu-d'm` --the legal-rep resema7ivak'6f-�detaae�i�mpi�er,
receiver or trustee of an individual,partnership,association or other legal entity,employing employees:However the
owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the
dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house
or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer."
MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or
renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any
applicant who has not produced-acceptable evidence of compliance with the insurance coverage required."
Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall .
enter into any contract for,the performance of public work until acceptable evidence of compliance with the in ice "
requirements of this chapter have been presented to the contracting authority."
Applicants
Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and, if
necessary,supply sub-conti-actor(s)name(s),address(es)and.phone'number(s)along with their certificate(s)of
insurance. Limited Liability Companies'(LLC)or Limited Liability Partnerships(LLP)with no employees other than the
members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have
employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial
Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should
be returned to the city or town that the application for the permit or license is being requested,not the Department of
Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers'
compensation policy,please call the Department at the number listed below. Self insured companies should enter their
self-insurance license number on the appropriate line.
City or Town Officials
.Please be sure that the affidavit is complete*and printed legibly..The Department has provided a space at the bottom
of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant
Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant
that must submit multiple permittlicense applications in any given year,need only submit one affidavit indicating current
• policy information(if necessary)and under"Job Site Address" the applicant should write"all-locations in (city or
tiown).".A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the
applicant as proof that'a valid affidavit is on file for fimturE permits or licenses. A new affidavit must be filled out each
year.Where a home owner or citizen is obtaining a license or permit not related fo any business or commercial venture
(Le.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit
The Office of Investigations would like to.dM*you in advance for your cooperation and should you have any questions,
please do not hesitate to give us a`call.
The Department's address,telephone-and fax number:
The C6ramonwealt1i of Massachusetts
Department of Industrial Accidents
r
Office of Iavestigations
- 600 Washington Street
Boston,MA 02111
TO. # 617-727-4900 ext-4'06 or 1-977-MASSAFE
Fax# 617-727-7749
Revised 11-22-06
www.mass.gov/dia
i
Town of Barnstable
Regulatory Services
vMAM z z~� Thomas F.Geiler,Director
Building Division
Tom Perry,Building Commissioner
200 Main Street,Hyannis,MA 02601
www.town.barngtabl e.ma.us
Office: 508-862-403 8 Fax: 508-790-6230
nY
ProP e Owner Must
Complete and Sign This Section
If Using ABuilder
as Owner of the subject property
hereby authorize LXc\, � C to act on my behalf,
in all matters relative to work authorized by this building permit application for.
C, tj
(Address of Job)
� � S
Signature of Owner Date
Ili Gh �V4d I `
Print Name
If Property Owner is applying for permit please complete the
Homeowners License Exemption Form on the reverse side.
O:FO RMS:O WNERPERMISSION
Town of Barnstable
Regulatory Services
r
RlRucrLAi P : Thomas F.Geller,Director
EoF Bnilding Division
Tom Perry,Building Commissioner
200 Mairi:Stree Hyannis;-MA-02-6,01 _.._. . . _._.._.....
w w vy.town.b arnstable-ma.us
Office: 508-962-4038 Fax: S08-790-6230
HOMEOWNER LICENSE EXEMPTION
Please Print
! 9 6
DATE: t� 1
JOB LOCATION: �ajtN fit
number V street r village
"HOMEOWNER':
name home phone# work phanc#
CURRENT MAII ING ADDRESS:
cityh mm 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. I`
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 u um
ndersigned"homeowner"asses responsibility for compliance with the State Building Coda and other
applicable codes,bylaws,rules and regulations.
The undersigned.."homeownee'certifies thathe/she understands the Tpwn of Barustable,Buijftg Department
minimum inspection procedures and requirements and that he/she will comply with said procedures and
requirements.
Signaturz 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 perFamimg work for which a building permit is required shall be exempt ftm the provisions
of this section(Section 109.1.1 -LieenSMi g of construction Supervisors);provided that if the homeowner cmgages a persons)for hire to do such
work,that such Homeowner shall act as sups visar."
Many homeowners who use this exearption are unaware that they are assuming the resparurbrlities of a supervisor(see Appendix Q,
Ruies&Regulations'for Licensing Construction Supervisors,Section 2.15) This lack of awararrSS 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 responnbilitics,many communities require,as part of the permit application,
that the homeowner certify that hdshe understiaids 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 sucb a fmmi/cextification.for use in your community.
Q:fornu:homcexempt
License or regish ation valid for individul
HOME IMPRQ�VEMENT CONTRACTOR use only
i Before the.expiration date. If found return to:
• ' Registration 138653 Board,of Building Regulations and Standards
Tr# 129940
Expiration 5/1%2.0,09 `, One Ashburton Place Rm 1301
Types Private Corporation Boston, Ma.02108
CGMPASS REALTY DE- PMENT CORP
MICHAE'L DEDECKO
25 CARLETON DR. �.
MASHF'EE, PAA 02649 �.
----------------------
Administrator . Not valid w.ithant signature
�^� .'bra �?T p'-W'�M ,��•+,�/,+�� O At'��{k ��
✓lie tf� ►a�+4� "" `i� 11�US +k
r �� Boayr`dk+ n � e>!�ltlr�t �w� dGds,
' 'c 4n jtr 000 A l Y ill A 7 M N; y i
0 V
t r�a {
S°. /9/2009
x
�xc j
(VtICHAELi DED
PO E}OX 2384/CARLTS�QR
5
��yofTNE,,�yo� TOWN OF BARNSTABLE
Z DABd9TAEL i
MASSACHUSETTS
Solid Fuel Stove Permit
DATE OF APPLICATION ............ .....V .:.....�....1.... ....7........ DEPT. ISSUING PERMIT �-A/4.................
NAME (owner) .......�L'.,C ........... '�F"Y11ff .�:+........................... NAME (Installer) ..............�1../...:.���...............................................................
� ... � .ADDRESS .��r'r................iv.{.. . . . -. -�d�.:..................'�................... ADDRESS ...........................................................................................................................
STOVE TYPE ........... .�C?... ............................................................................ CHIMNEY: NEW ........................ EXISTING .............
Manufacturer ............. .
`� 0..0-a ............................................................. CHIMNEY: Masonry ...............�.................................................................
.... ...........
CHIMNEYMetal ............. .'.�".Mass. Approval ........(PA,:.-.....1... .... ........................... ...........................................................................
This is to certify that the above installer has permission to install a solid fuel burning appliance at the listed
address in accordance with an application on file with the ................................................................................................... Fire Department,
and subject to the provisions of the Commonwealth of Massachusetts State Building Code and regulations made
under the authority thereof.
IssuedBy: .................................................................................................................................Title .................................................................................... Date ..........................................
Permit to install expires 60 days after issue date
StoveL.. � Cj ..............................................................................................................................................................................................................................................
StoveClearance ..................................................................................................:"tp............... .. ..... ..:. ........... ....... .... ..............................................................
Floor ................�..r�.......jY`....... dt��.J...... :,! .............................................................................................................................................................................
SmokePipe .................... '�... .......................................................................................................................................................................................... ........................
)�
SmokePipe Clearance .........L.�.............. .................. .....�f%! '................................................:.........................................:............................................................................................
Chimney ................... (.. .7 ... .....................................................................................................................................................................:.........................................................................
SmokeDetector .................411-11......................................................................................................................................................................................................................................................
The undersigned hereby certifies that the installation of solid fuel burning stove and equipment made under au-
thority of permit dated ...................................................... has been made in accordance with provisions of the Commonwealth
of Massachusetts State Building Code now currently in effect and pertaining thereto ........................................................................
Installer
4
INSTALLATION APPROVED .
�..5..1.�'' .�i....:.......�.�.�.1�.�..�....... By:...........1.... h:.`�'�... "......... ....�,.,�.................... Title: ...ae--t.jk?r...... .
date
WHITE: FIRE DEPARTMENT - CANARY: BUILDING INSPECTOR - PINK: APPLICANT
r
f
��yOfTNE 1p�`Ow
TOWN OF BARNSTABLE
S 13"ISTAn
'oo i639. MASSACHUSETTS
Solid Fuel Stove Permit
VS
DATE OF APPLICATION .....'...y........................:.....�.. .. :. ...... -4�Rffl DEPT. ISSUING PERMIT .................
NAME (owner) 1.�-!-ZA j t.? enn',"k............................ NAME (Installer) .............: ... +r ..................:..........:......:...................:.......
ADDRESSI�PJ.�I.Y!..:t.:�.....at Ad..............�..:...:.....::.............. ADDRESS ...................:.............................:............................:............................:..........:....
_ _
STOVE TYPE ........... ,JC7 �.......................................................................... CHIMNEY: NEW ........................ EXISTING ......�.......
Manufacturer C�Y � � CHIMNEY: Masonry .... .
J
......... ....................................... .....................
Q
u
Mass. Approval ........ ..-......: CHIMNEY: Metal
This,is to certify that the above installer has permission to install a solid fuel burning appliance at the listed
address in accordance with an application on file with the ................................................................................................... Fire Department,
f: and subject to the provisions of the Commonwealth of Massachusetts State Building Code and regulations made
under the authority thereof.
�r
. .
Issued By: ............................................................................................................... .......Title .........................................................................:......... Date ........................:.................
ti
Permit to install expires 60 days after issue date
Stove .......... W ............................. .......... ..... .
StoveClearance ......................................is ............................................�1/r? 4...... ....... . .............................................................
Floor ........;�Y� ..............................................................................................................................................................................
Smoke Pipe ....................... . .. ..........u!r.t .........................................:...................................... ..............................................................
.................. .........
SmokePipe Clearance ....:...........................................................................................................................................................................................................................................................
Chimney :4n r• ....... ................................................................................................................... .............................. .............. .................................................
•
Smoke. Detector ...........................................................................:............................................:.......................................:............:......................................
.............. r..................................
The undersigned -hereby certifies that the installation of solid.fuel burning. stove and.equipment made under au-
thority of permit. dated ...................................................... has been made in accordance with provisions of the. Commonwealth.
of Massachusetts State Building Code now currently in effect and pertaining thereto ..........:....:........................................................
Installer
INSTALLATION APPROVED .......................................�..,............ B ....... Title
date
WHITE: FIRE DEPARTMENT - CANARY: BUILDING INSPECTOR PINK: APPLICANT