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0170 FIFTH AVENUE (HYANNIS)
17C� �rF%ff AvE&ju, Engineering Dept:(3rd floor) Map 'p7 y,5— Parcel //S Permit# S J House# /` 6) Date Issued Board of Health(3rd floor)(8:15 -9:30/1:00-4:30)!3' aP7 ek ire Conservation Office(4th floor)(8:30-9:30/1:00-2:00) Planning Dept.(1st floor/Scho Bldg.) �1141 BE Definitive Plan Approved by PI and 19TI ,USA°BE INSTALL If PLIANCE N OF BARNSTABLENVI�ONyENTALC5 OD E AND Building Permit Application TOWN REGULATIONS Projec ree ddress Village &J, Owner--- .�,c/ S. i q re4,w&i5c ° . Address •7©--3 4 Si; Telephone '7'73' 7?ls5 Permit Request 47_ L First Floor square feet Second Floor square feet Construction Type Estimated Project Cost $ 6___ T Zoning District Flood Plain Water Protection Lot Size Grandfathered ❑Yes ❑No Dwelling Type: Single Family Uf_ Two Family ❑ Multi-Family(#units) Age of Existing Structure 6',0 &;l Historic House ❑Yes p1No On Old King's Highway ❑Yes p'lgo Basement Type: ❑Full ©'Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: Existing New Half: Existing New No.of Bedrooms: Existing New Total Room Count(not including baths): Existing New First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil ❑Electric ❑Other Central Air ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove ❑Yes ❑No Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) ❑Attached(size) ❑Barn(size) ❑None ❑Shed(size) ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# Current Use Proposed Use Builder Information Name 5f �` �s, ��tJ`l�f G-r�c� Telephone Number 7!?O 0 �Ilf r Address License# a p 7 5?7s-- -/Ai!/iy�S, ✓64, Home Improvement Contractor# 11666;9 Worker's Compensation# _ -7/1-08 19n-r"60796 NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO V o' Pas oyg/ SIGNATURE DATE 9 oh BUILDING PERMIT DENIED FOR THE FOLLOWINGR�EASON(S) (i y FOR OFFICIAL USE ONLY PERMIT NO. •_ - � ', • DATE ISSUED MAP/PARCEL NO. ' ADDRESS .» ` VILLAGE' ' OWNER t DATE OF INSPECTION: FOUNDATION �7Y�' ��✓5 �l eZ :is FRAME,,- INSULATION • FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH , FINAL GAS: . ROUGH E FINAL FINAL BUILDING . tj DATE CLOSED OUT ASSOCIATION PLAN NOS o)�p • r r - L]� uw n v'9 / El uooq.g3 •.....-..... i wnwv do I ! L r�l �j ® �• � �; �l' �: � � � �! -��-r—fir► �. 1 '/ ,►may �rei►y� r. The Town of Barnstable .. - eearrsr�ar.E, • `off Department of Health Safety and Environmental Services ► Building Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissioner For office use only ' Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the "reconstruction, alterations, renovation, repair, modernization, conversion, improvement, removal, demolition, or construction of an addition to any pre-existing owner occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors, with certain exceptions,along with other requirements. Type of Work: ��" �19�vS?IeV�1�0 Est.Cost G U Address of Work: f 70 -6-4-k- Owner's Name .4&Aj 1-4 Ce A.,J e Date of Permit Application: ?nl I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job under$1,000. Building not owner-occupied Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: Date ontractor Name Registration No. OR Date Owner's Name Th c• Cunmron ivealth of.1 k.,u ac h m etts Department of lndicrtrial.-iccitlents I liw; V'W1 oficeo//avest/gatlons • h(1(l Il<'ashinrtun ct S�rc a Buslott. Mass. 02111 ` Workers' Compensation Insurance Affidavit i Itc:tnt information: '-- Please i'R11VT'le��j,"""�""`"�'�•'�`' -"� �� name* lt�c�tion �b (7PTft j.,4 , city AW,iy 1/y(4- 0 nh me 0 _ 7'F®� Cl I am a Itomeowner performing all wort: myself. I am a sole proprietor and have no one working in any capacity I am an emplover providing workers* compensation for my employees working on this job. comnanv name: 4%l!!G ��, l.�tJ2�lE3� t7 l�C�. `�F 12& oeo-P-fJ-/.y2 address•96-9&4L i A lrfNAN.U! S L2(Q 'J'�6 '0 ! . city: nhnne#• 7 90-US-' el insurance cn / t/� �f �it/S'� noiic •# 7/0-03 67 !C [i I am a sole proprietor. general contractor, or homeowner(circle one) and have hired the contractors listed below who have the following workers' compensation polices: comnanv name: address: cin•: Phone#- insurnncc ro. comnanv name: add resc: nhnne#- insurnncc co Polito# Attach additional sheet if neccs_saty; ,.:•.. % - +_--+• - _ �""'"�"-�-•• y--+--� -�'- -•-- 7-7 F::ilurc to secure coverage as required under Section 25A of 111GL 152 can lead to the imposition of criminal penalties of a tine up io S1S00.00 andiur unc scars* imprisonment:IS well:rs civil Penalties in the form of a STOP WORK ORDER and a fine of SI00.00 a day against me. 1 understand that a cope of this statement mai be forwarded to the ollice of Investigations of the DIA for coverage verification. 1 do hereht•certify rider the pains and peenaaltlies of perjuty that the information provided above is true and correct. Sicnaiure ` ��-�li I 'ems'-z-�— Date � Z9 7 Print name `� �f � Phone# *7 90-• 0 P if official use unlp do nut write in this area to be completed b,, tiny or town official z• cit% or town: permit/license# riguilding Department C3Ucensing hoard [, C]check if immediate response is required OScleetmen's OMcc f E31lcaith Department . contact person: phone#: rnOther s. CC ' Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for th 31i. emplrn"cg . As quoted from the "law an cmphnree is defined as every person in the service of another under an\ contract of hire, express or implied. oral or written. An entplurer is defined as an individual. partnership, association. corporation or other legal entity•, or any two or inc the foregoing enuaged 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 owncr of a dwelling house having not more than three apartments and who resides therein. or the occupant of the dwcllin, house of another who employs persons to do maintenance , construction or repair work on such dweliing he or oil the ;,,rounds or buiiding appurtenant thereto shall not because of such employment be deemed to be an empioye MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant vw-ho has not produced acceptable evidence of compliance with the insurance coverage required. Additionally. neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter been presented to the contracting authority. Applicants Please fill in the workers' compensation affidavit completely, by checking the box that applies to your situation and supplying company names. address and phone numbers as all affidavits may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested. not the Department of Industrial Accidents. Should you have any questions regarding the "law" or if you are require to obtain a xvorkers' compensation policy. please call the Department at the number listed below. City or rowns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom the affidavit for you to fill out in tite event the Office of Investigations has to contact you regarding the applicant. Ple be sure to fill in the permit/license number which will be used as a reference number. The affidavits may be returned the Department by mail or FAX unless other arrangements have been made. The Office of investigations Nvould like to thank you in advance for you cooperation and should you have any questic 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 • fax #: (617) 727-7749 .,�,....� u• r41In !7.7_.490n Pvt. 106. 409 or 375 nce- e I ij ?"Tim !shed p a ! 1 I i � I .3 4 4 1�t 28z ► � " 114 f 110170 C4, i i ,101V 2 .57 two A I �+Ia 1 � i hm 9V cerrLfymace msm-Val • 'milr n rle � z Inc , duo 4a i !� Al haaz& arm wt'm. 7 -2 ~�Z ara ,the kicW � i T 3 �r� 7, i awl t1 WrU 1, 1AXtM rtS,9V�1 hoY't L �. d tlf��'d,,s1,0rial.! , lr,. y$ s PLEASE NOTE The ilructures mi shown irn this {slat plan arc approximatc�nnly. An ac-tual survey is n=5,,aly scar a precise determination m me rwilding Ixation me nuoichrmi?s. it ,-nV ;rtst, rithcr way :ace"M, i'lropertV lines. This, ;pian must not he u';ed ;01 recordlna, purtxises Sir 'or use in (7rrpamng deed 5c5cripuon5 and (nu=t ;lot Or. Q%?!0 "nr Vatlwice or building plan i rturi7oacti lhrti (Sian rrutit nc7( •?e aSeu ti! f<KaiC 7rt7perxv 11nes V=rt;icauu)ri of RU:(ding :matrons, property '.ine aimension5. fences I ur lot cord kguration can ontr he 3LLhrriol.slicd hV an �CCUrate l RrUrnent survn, 'wriich may rcllcci dttt;:rent intormaUOn than what I I is shown hereon. Please note :hat this ti '^IOT .A BOUNDARY -SUR`EY" and :s 17 R :ttQP' GA(iE PURK)rSk3 ONLY" COLONIAL LAND SURVEYING C M ANY NC.. ( 269 Hanover Street - Hanover, Klass. 02339 Phone: 417-826- 7186 • Fax: 617-826-4823 It r`frt lxr ,} sir ti7 i,r J) C { 5 `� `� _; NAMEpROYEMENr CONTRACTOR i� ire •�@gl$�f8hO1*1.Ny�n�6�`{b� ,�,.: s ,, .�.� 4 o �cp �q tC6/2'PI9@ LL 11 c 1 11141E � "' BEi�.LANE' wn r1 1: A -..ry., � • GTE �a� >�.�1r�1� !� �.,L���at� DEPARTMENT OF PUBLIC SAFETY CONSTRUCTION SUPERVISOR LICENSE Nutter: Expires: Restricted To: 11 BILLY E CAUTHEN 86 BETH IN HYANNIS, MA 12611 �� Y1-7 Assessor's map and lot number ...... ................................... IX Sewage Permit number ............................ O D yo*THETo�° TOWN OF BARNSTABLE i 33ARNSTIA"M i "6 .�� BUILDING INSPECTOR °�G MPY h• APPLICATION FOR PERMIT TO ...ff kle ..l........li.c. .� .....59/..... TYPEOF CONSTRUCTION ..................................... ........................................................................ a ...........19.A TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ....................................... /.. . .... (�5......:....kY� ........`, .(/ i� O.�l.. ...��d.. .5�............................ ProposedUse .............. ........i y7�........AxZor4.1v...........................................................I......................... Zoning District .............hle5.f.G1.1U1�..7/... 1...................Fire District ............. -.!. (�A'!. 1.�.. 5........................................ Name of Owner ........jff• �....... 1'?�l . ......................Address ...../!!L�/4 i .....!r!.✓�.,..... Name of Builder .... i7.✓.. .......5-w.r n'l.A.:...................Address ....t.?!�.... 1..!.<1....wee......1�:..!`/�/.1.�12Y�!,S�JQi-� Name of Architect Address ................................................................. ................ ...y............................/....../........................... Number of Rooms .Foundation .......... t� ..r..:. lQ�!1........................... t �i:fP...�d:t!/•!......-?�•�'!�`�q.�t�.�..:.........Roofing A/// c►.�; ...:!k t.�CI�S........C'�/!`P�Gf,�/ f61Pf" e, Exlerior ................ .. �1 Floors .............. ......................................................................Interior ..............�/as/e�/ pal- ............................. .................. .. Heating .....................�.`..a.A ..............................:..............Plumbing ........................iq.'2. .......................................... Fireplace ...............................................................:...................Approximate Cost .................... . Definitive Plan Approved by Planning Board -----------_______-----------19_______. Area ....../ ... ................... Diagram of Lot and Building with Dimensions Fee tz.L .. SUBJECT TO APPROVAL OFC BOARD_OF HEALTH ® x.. I hereby agree to conform to all the Rules and Regulations. of the Town of Barnstable regarding the above construction. Name ....................... .. ....... ......................................... Smart, Earl V No`.....177.02. Permit for enclose porch ..................... .......................................................................... Location 170 Fifth Avenue ............................................................... � We-s4—Hyannis�t .................................. .................................... Owner Earl Smart ................................................... , Type of Construction frame ................................................................................ Plot ............................ Lot ................................ t Permit Granted May 21 75 i Date of Inspection ... ..... ............ 9 ; Date Completed .!t. .. ..��....................9 P PERMIT REFUSED t i 19 ........................ ............... ................. i ...................................... ..................................... 1 { Approved ................................................ 19 t ............................................................................... ............................................................................... t a -... . �. Assessor's map and lot number Sewage Permit number r ,i` 7"ET°�° TOWN OF BARNSTABLE Z 9AUSTADLE. i "b .•� BUILDING INSPECTOR o war a- APPLICATION FOR PERMIT TO .. .. .•.. ... 1:..=C ... f .. �. .... ...... .••.f....•........ TYPE OF CONSTRUCTION t tr•,.-'c ..........19 F ............... ........ TO, THE INSPECTOR OF. BUILDINGS:? ` The undersigned hereby applies for a permit according to the following information: Location .................1................/... /!!1......./.(f..ve.............(N.....................(.....1..:....5 ..0.... 1....... fl.....:...................... ProposedUse ........... �.tJ.. /..0...!!1...........4 ..........kkhn.,�.?............................................................................ Zoning District ........... ...................Fire District ............ . ..%Jl.u!7.i u.6.L5............................................ Name of Owner ...................... �! /"�........ l7a' / f'J.... vP..................................... ........ ........ .... .............Address .... .................,�. Name of Builder """ COY../....... ................Address .......�.7a. ........... .. f� �.4`'..: r ........ Nameof Architect .............................................................:....Address ..................................................................................... Number of Rooms ..................................................................Foundation .........cC"lwc°.vl./.........9/9.C- ..5.................... Exterior ... le......... .......�F�/.::1. ylP...S.........Roofing 44. Floors I...-........� y....... . ....:.................Interior ..........z........l��r�n/............................ Heating .......................!!1/.Cf.!!!• ..........................................Plumbing . ..................................... Fireplace .......................................................:..........................Approximate. Cost ..................... .............................................. Definitive Plan Approved by Planning Board ________________________________19--------. Area l.. ...'................. Diagram of Lot and Building with Dimensions Fee i�� ............................................. SUBJECT TO APPROVAL OF BOARD OF HEALTH I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. i Name ......&— � .......... ::::.. /.................................... "Smart, Earl A=245-115 17702 enclose "orch _ No ............... Permit for .. .................................... ............................................................................... Location 170 Fifth Avenue ................................................................. Tmt Hyanni sgb*t ............................. ..... .................................... Owner .................Earl. ...Smart....... . ...... ..........:.................... Type of Construction ........fr.ame .... .:........................... Plot ...........:................ /Lot ........... .................... Permit Granted .....4f!y..21.................19 75 s9 Date of Inspection ....................................19 t Date Completed .. ..............19 PERMIT REFUSED ........................................ .................. 19 ................................ . ............................................. ............................................................................... 4. Approved .............................. . ............... 19 ........................ ...................................................... r. ............................................................................... e ......_...... P kip �. sv 30 .. . ........ el ,i ts a t h 4 � F I } ; y +5 t, i f �uN I I I � :E 4 'r C F S - R ,ft. l n4 e dv�,.r1 " �sp�►��� r���F-S�rr�.gl�S k-3o �i Pr' lSSS Z�-� It i i� X'o J4 bP p,)TiA-Oe, I I SeAle �/4 ��� ►e F, r �J 0 .4 mor f 1 1 i jerfrsff-:� e-4is7rN9 I vr� q� ' FO�N�9 �cvNi1R7� i j 14 k ` ` f k 6r i r0 O O O ---� i � R6 f 6uev-0,Q'rfpA �A �1 `•� BSc n le 4 . i C2) ,� l /� �' i 4 Ll I - - -� 4 71 i / Y ' r 3 -