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a Town of Barnstable C�l Permit# � /� o T)
Regulatory Services r'Fe s 6months omissue date
n�atvsrl+ars,
� , 19.. ��� Thomas F. Geiler,Director
prFO MAy�
Building Division ��
Tom.Perry, CBO, Building Commissioner X.PWIESS
200 Main Street,Hyannis,MA 02601 NOV —3 2014
www.town.barnstable.ma.us
Office: 508-862-4038
EXPRESS PERMIT APPLICATION - RESID TO K: 48�9,q 2,13$TABLE
EN RAL ONLY
Not Valid without Red X-Press Imprint
Map/parcel Number. 3(7
Property Address •�19.
[Residential Value of Work a0bo e-0 Minimum fee of$35.00 for work under$6000.00
Owner's Name&Address
Contractor's Name
Telephone Number 69' �
Home Improvement Contractor License#(if applicable)
Construction Supervisor's License#(if applicable)_ �
❑Workman's Compensation Insurance
Check one:
®' I am a sole proprietor _
❑ lam the Homeowner
❑ I have Worker's Compensation Insurance
..nsurance Company Name
Workman's Comp. Policy#
-opy of Insurance Compliance Certificate must accompany each permit
'ermit Request(check box) `
�Re-roof(stripping old shingles) All construction debris will be taken to ro
C�
❑ Re-roof(not stripping. Going over existing layers of roof)
❑ Re-side
#of doors
❑ Replacement Windows/doors/sliders. U-Value (maximum .44)#of windows
*Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc.
***Note: Property Owner must sign Property Owner.Letter of Permission.
Ajcothe Home Im rovement Contractors License& Construction Supervisors License is
r
iNATURE:
dTFILESIFORMSIbuilding permit forms XPRESS.doc
,ised 070110
v -Y
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston,MA 02111
www-mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
_Applicant Information
Please Print Le�bly
Name (Business/Organization/Individual): A�p
Address: -A a �l
City/State/Zip:
����ti�. VAH Phone#: 4D^ .. OD! ,
Are you an employer? Check the appropriate bog:
1.❑.I am a employer with 4. E I am a general contractor and I Type of project(required):
employees (full and/or part-time).* have hired the sub-contractors 6 ❑New construction
2. I am a sole proprietor or partner- listed on the attached sheet. 7. []Remodeling
ship and have no employees These sub-contractors have
working for me in any capacity, employees and have workers' g' ❑Demolition
[No workers' comp.insurance comp.insurance.$ 9. ❑Building addition
required.] 5. 0 We are a corporation and its 10.❑Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their
11.❑Plumbing repairs or additions
myself. [No workers'.comp• right of exemption per MGL �i
insurance required.]t e. 152, §1(4), and we have no 12.in Roof repairs
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.
tContractors 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$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby certify e e pa and pe es of perjury that the information provided above is true and correct
Si ature:
Date:
Phone#:
Official use only. Do not write in this area, to be completed by city or town officiaL
City or Town: Permit/License#
Issuing Authority(circle one):
1.Board of Health 2. Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6. Other
Contact Person: Phone#:
y
�JHE 7-1 Town of Barnstable t ..
Regulatory Services
a
BARNStABLY- ' Thomas F. Geiler,Director
KAAaMIL
Building Division
Tom Perry,Building Commissioner
200 Main Street,Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
Property Owner Must
Complete and Sign This Section
If Using A Builder
I, FIF T V I G+CW—m '(; 05kr—,as Owner of the subject property
hereby authorize 0011AAls Veil1. to act on my behalf,
ini all'matters relative to work authorized by this building permit application for'
2 s TEY A)e
(Address of Job)
Si ature of Owner Date
. P t Name.
If Property Owner is applying for pen-nit please complete the
Homeowners License Exemption Form on the-reverse side.
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Massachusetts -Department of Public Safety.
Board of.Building Regulations and.Standards
Construction Supen'isor ,f
License: CS-066582rt
THOMAS C WfIIFE
4 MAIN S
15A _
T
Centerville•MA 0632 I -
It t,��` Expiration
Commissioner 03/14/2b15
I�
i "F ,per -:_ ��ie�oai��rnaruuetcfG���C�e.�acf�.p�.Y
-- e.
f,ice of Consumer Affarcs&Business Regulattori
t
ME IMPROVEMENT CONTRACT
gistration: 11772g3..
xpiration q,22g2015+ LLG
I `Tt IOMA$C WHITE we:O-Dw-----ER LLC
( . fir~�
r1 t �
TH WAS WHITE
...p __.:
4115A-h11Alt�i ST. .CENTERVILLE,MA 02632 '
Underseeeetary
�t rti Town of Barnstable *Permit ACRO I ri
Expires 6 mon m�ae
�T Regulatory Services Fee
dmfp
IARNSPAsr.&
9� MASS.1639. Richard V.Scali,Interim Director
��
ArED MA'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 :30 6 1 q
Property Address j6 Yu l �Y(41011NAOI
KTResidential Value of k$ �� 0 Minimum fee of$35.00 for work under$6000.00
Owner's Name&Address
Contractor's NameI \l= � �j�TelephoneNumber. �(
Home Improvement Contractor License#(if applicable) Te ®� Email: c„9yc>C)� j\��F
Construction Supervisor's License#(if applicable) C� ' 0" F0%mQ 0.
❑Workman's Compensation Insurance
0 k one: MAY 12014
am a sole proprietor
❑ I am the Homeowner
❑ I have Worker's Compensation Insurance -rOWN OF
BARS1-ABL1e
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
❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof)
❑ Re-side
® Replacement Windows/doors/sliders.U-Value Qa aximum.35)#of windows
#of doors:
❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required.
Separate Electrical&Fire Permits required.
*Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc.
***Note: Property Owner must sign Property Owner Letter of Permission.
A copy of the Home mprovement Contractors License&Construction Supervisors License is
• e ire
SIGNATURE.
Q:\WPFILES\FORMS\huilding permit forms\EXPRESS.doe
Revised 061313
.2 to Commonwealth ufMassachus&Ys
Deparhum t of1admftial Accidents
- Office o,f In e5tigUdons
' 600 Washrrrtgton Street
Boston,MA 02111
wmv.mass,gavIdirt
Warkets' Compensation Insurance Affidavit:Builders/ContractorsMectricianslPlumbers
Aix. pcant Information Please Print Legibly
Name Uhi6 eWOzp=.aton(InEwdual):
Address: Ll "►J
CityfStatdZip(%r qKa%\mil« 4A 31Phone 4- —S y S l
Are you an employer?Check the appropriate born
Type a#proaect(rbgmrecl):
4_ I ate a contractor and 1 6_ ❑New amstractiou
I_❑ I am a employer with 0 �
employees(f-01 andlorpmt-lime}* have hired the sub-contractors
I am a sole proprietor or partner- listed on the attached sheet; 7_ ❑Remodeling
ship and bane no employees These sob-contractors have S. ❑Demolition
worlang for me in any capacity_ employees and have wodw s' 9_ ❑Building addition
(Noworlm'comp.i'ut mrxe comp.msumcf1 .
required] 5. ❑ Ate area corporation and its 10.0 Electrical repairs or additions .
3_❑ I am a homeowner doing 41 work ofEcers ha:vm exercised their 11-❑Plumbing repairs or additions
myself[No workers'CMP- right of'eiemption per MOL 121-1 Roof repairs
insurance r ]1 c-152,§1(4),and we have no
employees-[No warms' 13_❑Other
comp.msvrence recluired.f
*Amy sppUcmt d it checks box 91 mast also fiIl out the section below shay ing ibex wand us'compemadoa pormT iuRwmifien-
T Homeowners who submit this afdsvit in&csting they atm doing nnwak sad thew bum outside contrKmm amst skit a new affidavit mrbcatin mcTi
Z0Dntncmrs that check this box must attached as additional sheet showing the name of the and state whether ornot these Vibes have
employees If the svh-coutnictum lie empLofees,the}Tmrst pnrvide their warken'comp.policy number.
lam an employer that is pmtidiag tt�orkers'cotttpttrrmiion iuMirartcs for My empFayeas BeIoty fs Hie pviic}and job sum
infotma ia;n.
Insurance Comp&nyName:
Policy#cr Self-ins-Uc_4: FxplrationDate:
Job Sife Address: City/State/zip:
Attach a copy of the workers'compensation policy declaration page(shoving the policy number and expiration date).
Failure to secure coverage as retl iredunder Seetiort 25A of MGL c, 152 can lead to the imposition oferiminal penalties of a
fine up to S1,50000 and/or one-yearira nsonmeut,as well as civil penalties in the form of a STOP WORK ORDERand a fine
of up to$250_00 a day against the violator_ Be advised that a copy of this statement maybe forwarded to the Office of
Investigations of die DIPS liar insurance coverage verification_
I de hereby cerrp
xi ird alfies ofpedwy that the information provided a e is truce and correct
Sitmature: c-� Date: �e
Phone#: .�vc�"�
Ofj`—W use only. Do not write in this area,to be completed by do or town officiaL
City or Town: PermitUcense#
Issuing Authority(circle one):
1.Board of$ealth 3.Buff-ding Department 3.City1rown Clerk 4.Electrical inspector 5.Plumbing Inspector
6.Other
I
Town of Barnstable
Regulatory Services
RAMMEIM
MASS. �* Thomas F.Geiler,Director
.
i639� tea+
' 639 Building Division
Tom Perry,Building Commissioner
200 Main Street,Hyannis,MA 02601
www.town.barnstable.ma.us
Office.- 508-8624038 Fax: 508-790-6230
Property Owner Must
Complete and Sign This Section
if Using A Builder
PF�TI e- U ACO �� � ire
- Owner of the subject property
hereby authorize � C 0 �rcc to act on my behalf,
.in a rnaxtexs relative to work authonzecl bythis�bQdm .perm> `application
(Address of Job)
ignature,of'Owner. Date
P(Z-_T'Cx 1 f LA6001v Cori/ems OPantNara.
t I'ronertY Owners_applying:for.pernut:.please complete the
u ..
F'�omeowners L.i. ense Exemption-Form on-the.-reverse side.
I. ORMS:OwNERPERMISS ION-
Massachusetts -Department of Public Safety
Board of.Building Regulations and Standards
Construction Supervisor 9.
License: CS-066582
THOMAS C WHITE
j
415A MAIN ST k*
Centerville MA 0'2632 '.•
Expiration
Commissioner
03114/2015 .
eai��nzodiurea�G�o �/laeaac�uoeGYt;.1
free of Consumer Affairs&Business Regulation
ME IMPROVEMENT CONTRACTOR
gistration 1 7283 Type
xp
C.WHrITE WOR
ffi
ir `11/22/2015 LLC
THOMAS WOODKER LLC..
THOMAS WHITE
CENTERVILLE,MA 02632 Undersecretary
r ...
Massachusetts -Department of Public Safety .
Board of Building
Regulations and Standards
i
Construction Supers isor
License: CS-066582 t
I Ix ,
i THOMAS C W IITk
415A MAIN ST ,
Centerville MA 02632
,rw 1A, Expiration
Commissioner 03L14/2015
1.Ieense or registration valid for indivrdul use only
before the a prrati0n date If foun'd::return:_to_' .
Office of Consumer Affairs and Business Regulation
t( 10 Park Plaza.- —5170
fi Boston,MA 02116 s
of va id without signature
THE
TOWN OF BARNSTABL
� �� Ci
B9HB9T11BLB, i
M6 o w BUILDING INSPECTOR V�Q�
� ar a' Q'
co
APPLICATION FOR PERMIT TO Repair fire damage
..................................................................................... ..........
TYPE OF CONSTRUCTION ............Wood frame...dwelling.....................................
June 12
................................................19..3...
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according to the following information:
Location ..... 162.•.Estey Avenue, Hyannis, Massachusetts 0260.1
Proposed Use Dwelling
..................
Zoning District ......... ...'...............................................
......,fire District Hyannis
Name of Owner ......Paul E. Lacouture, Jr. Address 240 West Dixon Ave. , Dayton, Ohio
(P.O. Box 310}
Name of Builder Rogers & Marney., Inc. Address _. West Barnstab a Ad, Osterville
Name of Architect ••..None...................................................Address
Number of Rooms Four ..............................................Foundation .....Concrete biers
Exler:ior Wood shingles As halt
.........................................................................Roofing ................P.........................,,................_.....................
P1ne
Floors ................... ..................................................................Interior ......_..... pen..............................................................
Heating None Plumbing One bath
Fireplace .........One.................................................................Approximate-Cost ...�11,000.00..............................._......
Definitive Plan Approved by :Planning :Board -----------__—___-----------19________ .
Diagram of Lot and Building with Dimensions
SUBJECT TO APPROVAL OF BOARD OF HEALTH
`E l
hereby agree to conform to all the Rules and :Regulations of the Town o a st I reg ing .the ove
construction.
Name ... ..... ... .......
| �
Lacmuturev Paul E., Jr. �
'
'
No ..... Permit for ___ ..fire_ |
�
____ ...................................................... |
Location ..........l62. . ______
.........................Hyi�z...................................... ' |
�
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� Owner ----PaoI'E.... �'�r"--
�
� Typo of Construction .................If rXJRP----..
--------------------------. .
plot ---------.. Lot ----------..
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Permit G,ono*6 .........
--......lP ��
-
Dote of Inspection ^ lP
p|e�e6 '
V!0;�
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PERMIT. REFUSED
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Town of Barnstable Permit# �=
Regulatory Services Fee Z�- y
BAMS AM, ' Thomas F.Geiler,Director
16 9. sion,;;. . ,
k
Elbert C�Ulshoeffer,Jr. ldmg Comm�suiperJ
-'•.,-c '.:.yam '•3'. >, 1 r'.j} -Zw`'[.l ��+ }i,:.
367 Main Street, Hyannis,MA 02601 , C
0
AUG SS
Office: 508-862-4038 7,0VV 2001
Fax: 508-790-6230
EXPRESS PERMIT APPLICATION o�eARNSTq
Map/parcel Number '30 (0 1"1 S
Property Address (D 2 tF_-,,r F_A A-4 l:tJ V E A 14 to�`7
Residential OR ❑Commercial Value of Work '06 l0.000
IK � Ai n uruy HNI�I.. M./��1
Owner's Name&Address �1��..,�, ,.-.,.,� .� ,.� . �....��,
Contractor's Name Telephone Number$60 1 W1 -1-A 3`k
Home Improvement Contractor License#(if applicable)
Construction Supervisor's License#(if applicable)
[:]Workman's Compensation Insurance
Check one:
I am a sole proprietor
I am the Homeowner
I have Worker's Compensation Insurance
Insurance Company Name C fi� me moli5 -eg
Workman's Comp.Policy#
Permit Reauest(check box)
Re-roof(stripping old shingles)
Re-roof(not stripping. Going over existing layers of roof)
2"Re-side IuST 1N AaeA OF I�AZW W 11Joor.3S - A?PrLoY,1t`,A*re L_-j -A00
CD S „o t•J l�
[Replacement Windows. U-Value (maximum.44)
Other(specify)
�E'ASE r`10'� Y�ovSC. �S Sut�Mt✓tt c-t)T'�'R 6� v n1 1-{•E/�'T�p
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PROPOSED REAR ELEVATION
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PROPOSED ELEVATIONS 2
Q Q PROPOSED RIDGE HEIGHT: 42.5 0
O K ALLOWED PLATE HEIGHT: 30.0
ACTUAL PLATE HEIGHT: 20.8 mE use oP mese oRAvnxes trW6
in SECOND FLOOR ELEVATION: 26.0ern �n4e io BeuMneo*o ms
�p Q H - sreanc rRD�eQ ux,e55 em—ED
F M FIRST FLOOR ELEVATION: IG.0 wu�n«w�eiur is cveu Br nnRrroi
= TOP Of FOUNDATION WALL 14.5
FLOOD ELEVATION: 13.0 REVISIONS
(D AVERAGE GRADE: 11.8
g BASEMENT ELEVATION: 7.5 0 Qy raR.vrRo
® ® ® RECE �xe,4eB,
T�/}��' NOTE
� Z �' +-�� FOR EXTERIOR STAIRS,GRADES AND OTHER
I 517EWORK 5EE5ITE5URVEf Q
■Prel mealy Not for Construct on
b g 9 2015 ■Issued for Comments.
` ■Issucd For ZBA approval'23.2015
LLJ (^l�® ■Issued For ZBA approval June 25.2015 Q
_ — — I�TTi ��T �p�'��1 w rl Issucd for B,dm. �
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i.orz r o rr e�:,as'
rl Issued for Approval
lit <V
v �Ownr-r xu:.meo
Stone landings and stairs _ D 1M 2M 3M
PROPOSED FRONT ELEVATION
DRAWNG NUMBER:
4I 1234 8768 _
D FT 5 FT LOFT
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PROPOSED SIDE ELEVATION Q
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SECOND FLOOR ELEVATION: 26.0 �
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FLOOD ELEVATION: 13.0 me use or mere DRAwlues nw+s
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p[ _ BA5EMENT ELEVATION: 7.5 c new go�exr is erveu sr nARrrp
® ® ® ® g NOTE:
Z REVISIONS
ALL SIiE GRES AD TAKEN PROM PLAN ENiRLPD:
PLAN TO ACCOMPANY A 20NING aN A.BOARD OF APPEAI5 FILING x°
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�rizsrr�Dozeuc.° _ _.— _ — —.—._._._ —.—._ .. Rsr noil[,e_g—._ / — _ _ —.— ■Issued for Comments.
Y ■Issued for ZBA avvroval.April 23,201
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n Is5ued for Permit.
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rftO°�°6`'euRvzr N — — n I55uc1 for Approval of:
L_ ! ■Owner Iv.xx.eea
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DRAWINGAUMBER: ///\)
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relimmary Not or onstructlon. Q
I - ■Issued for Comments.
■Issucd for ZBA aoOr-1.Annl 23.2015
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BASEMENT PLAN
DRAWING NUMBER
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REVISIONS
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SECOND FLOOR PLAN o
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■Prelimnary Not for Construction.Q
■Issued for Comments.
IN Issued for ZBA approval.Avnl 23.20 1 5
■Issued for BA approval.June 28.201 5 Q
rI Issued for Pcrmd.
n Issued for Bids. p„
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4 fl Issued for Approval of:
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f DRAWING NUMBCR:
1 2 3 4 6717 6 6 A 4
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