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0048 FOURTH AVENUE (HYANNIS)
L{8 �b�w� �v�. _ .__� . �� �� TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION t` �;;�, `�= Mapes Parcel 0�� Applica� Health Division Date Issued Conservation Division - Application Fee x/ Planning Dept. Permit Fee _ Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Street Address LI S Village /Ip,�JJu+S ;�` ► Owner Address UM Pc\1C Telephone —1-1L1 — "7 • OMWE Permit Request — -_ ........... Square feet: 1 st floor: existing UQ(.proposed 2nd floor: existing proposed = Total-ew C- Zoning District Flood Plain Groundwater Overlay Project Valuation Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting dacurn ation. Dwelling Type: Single Family O Two Family ❑ Multi-Family (# units) CZ) i77 Age of Existing Structure \CA%3 Historic House: ❑Yes Flo On Old King's Highway: ❑Yes U No Basement Type: `d Full ❑ Crawl ❑Walkout ❑ Other , Basement Finished Area (sq.ft.) O Basement Unfinished Area (sq.ft) \ \ Ce Number of Baths: Full: existing 2 new Half: existing new Number of e drooms: existing —new Total Room Count (not including baths): existing (—new First Floor Room Count 61�> Heat Type and Fuel: U Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes id No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size — Barn: ❑ existing ❑ new size_ Attached garage: ❑,existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑_ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name w\\on-tAIC%l Telephone Number Address ��®� '1 License# �33ZS lS C�IZC��'� Home Improvement Contractor# \(oS Za o � -ma 6) C��orkr s Com�ation # ALL CONSTRUCTION DEB S RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE FOR OFFICIAL USE ONLY APPLICATION# r DATE.I_SSUED - MAP/PARCEL NO. ADDRESS VILLAGE _ OWNER _ DATE OF INSPECTION: QAFOUNDATJ.ON, ,'lHg.", FRAME FIREPLACE ELECTRICAL: ROUGH FINAL s ' PLUMBING: ROUGH FINAL 4 GAS: ROUGH FINAL FINAL BUILDING-.... x'= ' ` DATE CLOSED OUT F ASSOCIATION PLAN NO. The Commonwealth of Massachusetts . Department of Industrial Accidents , Office of Investigations ' 6#0 Washington Street Boston,M4 02111 www.ma=goVdia Workers' Compensation Insurance Affidavit:BmidersJC;ontractors/ElectriciansOumbers Applicant Information Please Print LeaNy Nazne(Busmessloigan�iamllndividual): 12� -� C�c C �0,�1 i��� Ad&.ss: �'� \ZJQ1 Q LZ 9,A I\A CitylStatrJZip: (XGL6 Phone 47- Are you an employer?Check the appropnate box: Type of project r �-. I am a metal c�ontiactor and I YPs �] (required): 1.❑z1am, a employer with ❑ g 6_ ❑N oomstrtrction oyees(full and/or part-time).* have hired the sub-camtrsctois2_ a sole proprietor or _ listed as the attached abet. y deg These sub-contractors have ship skid have no employees 8_ ❑Demolition working forme in any capacity_ employeesand have wod=s' 9_ El Building addition [No[IioTjCt'_rS'comp_innuance Comp.msuranCe.1 required] 5. ❑ We are a corporation and its 14.❑Electrical repass or additions 3_❑ I am a homed mer doing all work officers bace exercised their 11-❑Plumbing repairs or additions myself[No workers'comp- right of memptiaa per MGL 12_❑Roaf repairs insurance required.]I c.152,§1(4),and we have no employees-[No workers' 13.❑011tetr comp.insurance required.] *Any apphcam fhat checksbm#1 mast also fill out the sectimnbelow showing rhek woMeis'eompensaf-policp infOrmalioa. I Horawwnes who submit this affidavit indksting tLey an doing all wa&and then hire outside cmxtmctnn must submit a new Affidsvi3 ind]C M%sack tContiactnrs that check this boar must attached an.additinna!shad spewing the muse of lhe sub-cmnuacton snit state vrhedw m not thmse entities have employees. Ifthe sub-contactors hone employees,they==pmvide dbdr workers'comp.policy mtmber. I tan au employer flint is providing workers compensation insurance for my enrplbyem Delotr h thepoiicp and job site infortriatiori. Insurance Company Name: Policy#or Self-ins-Lic.#: FxpirationDate: Job Site Address: CitylStatel7ap: Attach a copy of the workers'compensation policy declaration page(sh wing the policy number and expiration date). Failure to secure coverage as omVired 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 ear imprisonment,as well as cavil penalties in the form of a STOP WORg ORDER an fine d a of up to$250-00 a day a e violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA insurance coverage verifcation. I do hereby certify.urtdt r a pains and pen abias ofpedury Aatthe infona dianprotRdetl'above is true ante correct Si lure: ? Date: t� Phone#: O,,)icial uss mrF,}z Do not write in this area,to be campIded by city ortma officiaL City or Town PermitUcense# Issuing Authority(circle one): 1.Board of lgealth 2.%Hding Department 3.CittpTown Clerk 4.Electrical Inspector 5.Mimbmg Inspector 6.Oather Contact Person: Phone 9' 6 Town of Barnstable Regulatory Services r KASS. Thomas F.Geiler,Director 6 ►'� 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 �.�� �►f�, , -,,Property Owner Must, r. Complete,and Sign This Section ` If Using A Builder I, as Owner of the subject,property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit (Address of Job) **Pool fences and alarms are the responsibili' `'of lie applicant� ools' 4 are not to be filled or utilized before fence is ' stalled and all final inspections are performed and accepted. Signature of Owner S' ture of Applicant Print Name- Print Name Date QTORM&OWNERPERNSSIONPOOLS 62012 Town of Barnstable Regulatory Services rAse. Thomas F.Geiler,Director 6 ►`°� Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 � —to —bar:stable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION DATE: ` \ Please Print JOB LOCATION: Lil eUQ''`t1 AV(} '�N.J�►S ��0?\ number street , village "HOMEOWNER": S\ 4JJ k1TRR'FMK —I ILA L'�CN i—1 C name home phone# work phone# CURRENT MAILING ADDRESS: _C�t' l� city/town'" state zip���Z�ZS� U+7 e 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 thatthe owner acts as supervisor. DEFINTITON 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 compliarice with the State Building Code'and other applicable codes, bylaws,rules and regulations. The under igned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection prose and requireme and that h e co y with said procedures and requirements. r o Homeo e Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q,Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor."On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. C:\User;\decoUfic\AppData\Local\Microsoft\Windows\Temporary Internet Files\ContentOutlook\QRE6ZUBN\EXPRESS.doc Revised 053012 Massachusetts -Department of P.ublic.safety' Board of Building Regulations and.Standards he Construction Supcn'isor - License: CS-093325 a MICHAEL B BAOR 78 BRIDLE PA TI3 Matstons Mills 1VA 026A8; �. OB/06/2015 Commissioner Office of Consumer Affairs andVUSiness Regulation 10 Park Plaza - Suite 5170 Boston Massachusetts 02116 Home Improvementr'oxt ' for Registration -T Registration: 165291 Type; Private Corporation Expiration: 1/27/2014 Tr# 220820 TRADEMARK PROFESSIONALS MICHAEL BAKER 78 BRIDLE PATH '�;� MARSTONS MILLS, MA 02648 ►'„ Update Address and return card.Mark reason for change. Address [] Renewal 7 Employment Lost Card OPS-CAI 0 SOM-04/04-010121e x Ofttaa oZ4onsumcrnf a ra au a a D sinoes n Y License or registration valid for indlvidul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: IRegistration: ,,, 1;88281 Type: office of Consumer Affairs and Business Regulation Expiration: �`f/27l'g014 Private Corporation 10 Park Plaza—Suite 5170 - .,; Boston MA 02116 T TVA Pik. M E} 4�yNAGfS'r,' MICHAEL HAKE 78 BRIDLE PATHak MARSTONS MILL N4otnarsecrary ithout signature t... t �OF`"E r To* wn of Barnstable *Permit# 1 Expires-6 months from i e Regulatory Services Fee > sTns , : Thomas F. Geiler, Director y hcnss. 4, i6)j9. . Building llivisinn plFb Mai°' , Tom Perry, CBO, Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.barnstablc.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 Property Address 42 '1[�Residential Value of Work J u Minimum fee of$25.00 for work under$6000.00 Z.� S , , Owner's Name Bc Address :S t4/,1 `'>J L LJ F�ti to Contractor's Name s e, ✓;S ''L __ Telephone Number S�y�' 2�'{^ 2 T"2 j Home Improvement Contractor License# (if applicable) l ❑Workman's Compensation Insurance `� Check one: PRESSPERMIT I am a sole proprietor SEP 1 2❑8. ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance TOWN OF BARNSTABLE Insurance Company Name Workman's Comp. Policy# 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 ❑.Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side Replacement Windows/doors%sliders. U-Value ' (maximum..44) C^', *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e., istoric,"ervativi,etc. �C7 'Note: Property Owner must sign Property Owner Letter of Permission: : �— A copy of the Flome Improvement Contractors License is required. Z `A N SIGNATURE: Q:\WPFILESTORMS\building permit forms\EXPRESS.doc Revist020108 The Commonwealth of Massachusetts Department of.industrial Accidents Office of,investigations 600 Washington Street Boston, AM 02111 www.mass.gov/dia. Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers A licant Information Please Print Legibly_ Naina (Busincssl nizationllndividual): CitylState/Zip: w✓ wt }1� �i/� Phone.#: S�o — 2 Are you an employer? Check the appropriate bow Type of project(required): 1.❑ I am a employer with 4. I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sttb-contractors 2. I am a sole proprietor or partner- listed on the attached sheet 7. ❑Remodeling ship and have no employees These sue-contractors have g, �Demolition employees and have workers' working for me in any capacity. $ 9. []Building addition . [No workers' � rn p.- srtranc_c O°mp'=urance.We arc a corporation and its 10.0 Frlcctrical repairs or additions requirred_] 5. [] 3.❑ I am a homeowner dining all work officers have exercised their 11.0 Plumbing repairs or additions myself [No workers':comp. right of exemption per MGL 12 ❑goof repairs insurance required]f c. 152, §1(4), and we have no employees. [No workers' 13.[] Other rump.insurancr required.] tfwy applicant that check box#1 must also fM out the section below showing their wm-k='cmnpauation policy infomatim. t Fion=waczt who submit this affidavit indicating dbey are doing all work and then hire outside contractors must submit anew affidavit indicating such. tc=tractors drat cbxk this box must attached an additional ch=t showing the name of the sub-contractors and state whether or not thosd entitics have canploycs. If the sub—,ontracton have ranploycrs,they nnrst prwidt their wmiccn,comp.policy number. I am an employer thaf is providing workers'compensation insurance for my emproyees. Below is the policy and job site information. Incrira_nc.m Company Name: Policy#or Self-ins.Lie_#: Expiration Date: Job Site Address: City/Star-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 lean to the imposition of criminal penalties of a fine tip 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$250.00 a day against the violator. Be advised that a copy of this statcmctit may be forwarded to thr:Office of Investi tions of the DIA for incnraame Govern e verification. I do hereby certify under the pains-and penalties ofperjury that the information provided above is true and correct Datr, I L(2 Phonc# b g. — `2 O feeler!use only. Do not write in this area, to be completed by city or town officiaL City or Town: Permit/License#. Issuing Authority(circle one): 1.Board of Health 2.Building Department 3. CitylTovtm Clerk 4.Electrical Inspector S.Plumbing Inspector 6. Other eve n. Phone,#: 0*IHEr, Town of Barnstable Regulatory Services ±VBARxSTABLE'$ Thomas F. Geiler, Director . 059. Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.barnstable.ma.us Office: 508-862-403 8 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder T SLG.'.✓t: '50 as Owner of the subject property hereby authorize AO V d':5 Uu to act on my behalf, in altmatters relative to work authorized by this building permit application for: (Address of Job) GI 1 e o Signature of Owner Date s�G✓o vl s1iJ C�� 'c.,.,� Print Name If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. Town of Barnstable �oFSt+e ray Regulatory Services -� Thomas F.Geiler, Director • BARNSTABLE, 9 MASS.. Building Division PIEo '�a Tom Perry,.Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.barnsiable.ma.us Office: S08-862-4038 Fax: 5.08-790-6230 1T0114EOWNER 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-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s) who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be, a one or two-family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official, that he/she shall be responsible for all such work performed under the building permit. (Section 109.1,1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she-will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 1o9.],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 supesor." y rvire assuming the responsibilities of a supervisor(sec Appendix Q, Man homeowners who use this exemption are unaware that they a 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 Aith 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 helshe 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 forrn/certification for use in your community. 7 ✓/xe �om�naaariecr�Cl `Board of lluwlding Regulations and Stand a' L icensc or registration valid for mdividul use only HOME IMPROVEMENT CONTRACTOR before the,expiration date.,:If found?ret�►ru to ( Bdard,of Building Regulations and Standaf. s Registration 11:1448 r Qne Ashburton Place Rm 1301 Expiration 12G29/2008 Tr# 1 5794 s ..� -go,ton,AIa,.0210.8 " I>' Typef ndividual • Wj } ROBERT B. MORRISON „" ROBERT MORRIS,N 49 MELVILLE RD. w= "' ��� = s — 4 S YARMOUTH,Mid 0266 �dmmiairat�r �� iN t 1hd withou signature a 3. r Town of Barnstable *Permit# � Expires 6 months from issue date Regulatory Services Fee : Thomas F.Geiler,Director 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 rCe L r Map/parcel Number V Address ential Value of Worlc�'G r0 i Mim�um fee of$25 0 f�wo k under$6000.00 Owner's Name&Address Contractor's Name Telephone Number -Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) X-PRESS PERMIT ❑Workman's Compensation Insurance Check one: O C T — 5 2007 I,V,ra sole proprietor U411 am the Homeowner TOWN OF BARNSTABLE. ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must be on file. _ Permit Request(che `box) e-roof(stripping old shingles) All construction debris will be taken to— CIA ❑Re-roof(not stripping. Going over existing layers of roof) ❑. Re-side ❑ Replacement Windows/doors/sliders. U-Value ............ *Where required: Issuance of this Permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. r; , Note: Property Owner must sign Property Owner Letter of Permission:U A.copy of the H e Improvement Contractors License is required.; o SIGNATURE. Q:Forms:expmtrg Revise061306 i The Commonwealth of Massachusetts Department of Industrial.lccidents Office of Investigations 600 Washington Street Boston* ,MA 02111 ' www.mass.gov/dia Workers"Compensation Insurance.Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information. Please Print Legibly Name (Business/Organization/Individual):, •Address: City/State/Zi Ally one.#: Are you an employer? Check de appropriate box: -Type of project(required):, 1.❑ I am a employer with 4. [] I am a general contractor and I . employees (full and/or part- have hired the sub-contractors 6. ❑New construction . 2.❑ I am a'sole proprietor or partner- listed on the-attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have I 1 g• ❑Demolition working for me in any capacity. employees and have workers' insurance.$' 9• []Building addition o workers' comp,insurance co�• required.] 5• ❑ 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 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 A 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 providb their workers'comp.policy number. lam an employer that is providing workers'compensation insurance for my,employees Below isthe 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,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 IDIA for insurance coverage verification I do hereby certify un er the pains-and nalties ofperjury that the information provided above is true and correct: Sienature; Date: — — Phone #: Official use only. Do not write in this area,'to be completed by city or town ociaL City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3. City/Town CIerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: �oF�HET Town of Barnstable Regulatory Services ELU MsreBLE. Thomas F. Geiler,Director arwss. �pr 1639. A.�� Building Division ED AAA'I , Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 ------------------- HOMEOWNER LICENSE EXEMPTION /f Please Print DATE: JOB LOCATION: num r street. villa (/ "HOMEOWNE name home hone# work phone# CURRENT MAILING ADDR S: IZA�city/t n ( state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be, a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner".assumes.responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned`.`homeowner"certifies that he/she understands the Town of Barnstable.Building Department. minimum inspection procedures and requirements and that he/she.will comply with said procedures and require ts. ure of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet_ or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s).for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes _ ❑No If.y_es,site-plan review# Current Use Proposed"Use BUILDER INFORMATION Name cl y�1�11LY1 V - �- ' Telephone Number Address ``� A.""Cr License# (32 7SSR Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATUR DATE G /O 7 vcl`l/ZQYI �� �1C ' `. .• -s. '.,r'e.�r ec:. s;�> .� ._r•;r: .. ..n .. _. r i ,, £ - .. -r..-., .+. ,,;+ry ."" �"', .AW.r;.� -. TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION_ Map Parcel I O LI Application Health Division Date Issued-" Conservation Division "Application Fee !J� Tax Collector -' Permit Fee t Treasurer Planning Dept. Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address Ed 0 L-/-i Village > y����� �±-orz'�- D 2 6 9 :Z Owner Address Telephone -y�' °� 9'V e p Permit Request CR&-M vf e Square feet: 1 st floor:existing proposed 2nd floor:existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation A7060 Construction Type Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes ❑No On Old King's Highway: ❑Yes _0 No Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other c--i Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Plumber of Baths: Full:existing new Half:existing I neW 7 Number of Bedrooms: existing newall Total Room Count(not including baths):existing new First Floor Room ount Heat Type and Fuel: ❑Gas ❑Oil ❑ Electric ❑Other Central Air: ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑No Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage:❑existing ❑new"size— Shed:❑existing_❑new size Other: ` Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# Current Use Proposed Use B^,UILDER INFORMATION Name �� ( � �1 too 4R phone Numbers� Address �/ DES ®� Lice # C- � 6 9 �rn,ocrr�•v Qv 007T Home I rove Contractor# Worker's ompensation# ALL CONSTRU ION EBRIS RESU TING FROM HIS PRO ECT WILL BE KEN TO SIGNATURE DATE - I,' t: FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. r ADDRESS VILLAGE ' OWNER a DATE OF INSPECTION: t FOUNDATION FRAME INSULATION FIREPLACE -090 T d/off ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING �X. 1 .y f DATE CLOSED OUT ,Y ASSOCIATION PLAN NO. 5 / { CIle , I C:.�f ic�i nca,i a Boft ard of Building egulations One Ashburton Place, Rm 1301 Boston, Mo2108-1618 License: CONSTRUCTION SUPERVISOR LICENSE,_ _ Birthdate: 02/16/1957 Number: CS 037559 Expires:02/16/20 Restricted To: 00 3 _=- f4 .. DAVID P JOHNSONm __ } 143 PALMER AVE#B -- FALMOUTH, MA 02540 __-- Tr.no: 16470 Keep top for receipt and change of address notification. DPS-CA1 dS SOM-04/05-PC8698 oaro ui in e u ati/ns an an ar�s� g g One Ashburton Place - Room 1301 Boston. Massachusetts 02108 Home Improvement0i2 ractor Registration Reqistration: 102761 r ` Type: Private Corporation _ xfi Expiration: 7/2/2008 is � ���� .-�fM, JOHNSON HOMES INC.. twt David Johnson. ` 143 Palmer Ave Falmouth, MA 02540 ,y. -- --- -- --- --- Update Address and return card.Mark reason for change. " -•3 "� L) Address (_i Renewal r` Employment Lost Card DPS-CA1 0 5OM-05/06-PC8490 -- ---— p. - .. . � Board o w ing�egu�'at s Cn t ffards----- . License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Reglstratii 02761 Board of Building Regulations and Standards >,_,� One Ashburton Place Rm 1301 Exp`iratio.n,_12120089 -F-1 Boston,Ma.02108 C k Tpevtg�Corporation JOHNSON HOMES;` l. i --�.A - i David Johnson • 143 Palmer Ave - � � f' Not valid without signature" ` Falmouth,MA 02540 �-t`•;�==- Deputy Administrator -- IJ � o m m . CJl (11 LD ✓ � "i � � 1J461"o ui a ati�ns��arsLn g gu m °° . One Ashburton Place - Room 1301 � � p CD Boston, Massachusetts 02108 W Home Improvement Contractor Registration -- - --- f�CE{IJEI4LIUIF. 1102761 Type. Private Corporation Expiration: 702008 JOHNSON HOMES INC.. David Johnson 143 Palmer Ave -- -- -- - - - Falmouth, MA 02540 Update Address'and return card. Mark reason for change. i Address - Renewal = - Employment Lost Card DPS-CAI A C-Dg-6,U6PGCC8�449D Boar�o"FB pug egup``Iatoizs�oi� tan a� License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registratipfi ..i427Ei1 Board of Building Regulations and Standards ExpiratiQri:.-fj o 08 One Ashburton Place Rm 1301 =-_ -- — Boston,Ms.02108 , Jg�eF_Privte.Corporalion I JO HNSON HOME4 ilfQ� I, David Johnson _ 143 Palmer Ave Falmouth,MA 02540 Deputy Administrator Not vaIid it tgnature � . D m m Department of Industrial Accidents Office of Investigations 600 Washington Street •w� Boston,MA 02111 ^M 5 www massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): 73&sm , es Address: 1Y3 AAcr Ayr4oe- City/State/Zip: An MOU M. W-SY0 Phone#: /UK= A,reeyyou an employer?Check the appropriate box: Type of project(required): 1.U 1 am a employer with._ 4. I am a general contractor and I 6. ❑New construction , employees (full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. $ 7• ❑ Remodeling ship and have no employees These sub-contractors have 8. ZDemolition working for me in any capacity. workers' comp. insurance. 9. ❑Building addition [No workers' comp. insurance 5. ❑ We' are a corporation and its required.] officers have exercised their 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL I I-❑ Plumbing repairs or additions myself. [No workers' comp. e. 152, §1(4),and we have no 12.❑ Roof repairs insurance required.] t 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: #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. �r1erIC. oaq/ Policy#or Self-ins.Lic.#: WC- 6 T.T;3(a 9.2 Expiration Date:®%!hz 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 cent'. under the pains and penalties of perjury that the information provided above is true and correct .Signature: / .:Date:- ` a 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#: AG,ORD CERTIFICATE OF LIABILITY INSURANCE CSR JOHNH02 Cz DATE( IDD/05 22/06 r PRonuER THIS CERTIFICATE IS ISSUED AS A MATTER F INFORMATION ONLY AND CONFERS NO RIGHTS UPON TH CERTIFICATE Paul Peters Agency, Inc. HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR P 0 Box 669 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. '.mouth MA 02541-0669 ,__one: 508-548-2500 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: American International Cos. Johnson Homes, Inc i INSURER B: % David & Steve Johnson INSURERC: 143 Palmer Avenue INSURER D: Falmouth MA 02540 INSURER E. COVERAGES 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR NSR TYPE OF INSURANCE POLICY NUMBER DATE MM/DD/YY ATE MM/DD/YY LIMITS + .-GENERAL-LIABILITY ..._...___.. EACH OCCURRENCE $ Io1XGE COMMERCIAL GENERAL LIABILITY PREMISES Ea occurence $ CLAIMS MADE u OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GE N'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ POLICY PRO LOC JECT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $ ALL OWNED AUTOS' BODILY INJURY SCHEDULED AUTOS (Per person) $ " HIRED AUTOS ' �. ., . .. . '.BODILY INJURY' :. ..:. • NON-OWNED AUTOS ... .. .. .._ _.. fir. ... .. .. . ,, ... ....,.. ... .,. ., .. - PROPERTY DAMAGE (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND TORY LIMITS X ER _ A EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE WC6553692 � 102/04/07 02/04/08.- E.L.EACH ACCIDENT s500,000 OFFICERIMEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $500,OOO If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $500,000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Carpentry - Residential Dwellings CERTIFICATE HOLDER CANCELLATION YARMT01 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL.10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL Town Of Yarmouth IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THEJOURER,ITS AGENTS OR Off Station Ave = So Yarmouth MA 02664 REPRESENTATIVES. AUTHORIZED REPRESENT VE Joanne M. Jona ' , ACORD 25(2001/08) I,. ©AC CORPORATION 1988 10/' 2001 1:21 PM, FROM: Fax TO: 1 508 564633o PAGE: CC1 CF 002 ACORD CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDNYYY) rnr 10.01.2007 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION. ArthurD.Calfee Insurance Agency,Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER, THIS CERTIFICATE DOES NOT AMEND, EXTEND OR www.calfeeinsurance.com ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, 336 Gifford Street Falmouth IIRA 02540.2967 INSURERS AFFORDING COVERAGE NAIC# INSURED Kevin W.Winters INSURER A Arbella Insurance 75 Two Ponds Road INSURER B: American Home Assurance INSURER C: Falmouth MA 02540.2221 INSURER D: INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT, TERIA 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. r INSR DDT I POLICY EFFECTIVE POLICY EXPIRATION POLICY NUMBER LIMITS GENERAL LIABILITY EACH OCCURRENCE $ PJ,•L4'E TO REPJTEC COMMEP.CIA GENERAL LIAEILITY' E l a ' ' CLAIMS N'ADE OCCIUR MED EX� Any one)erscn) $ PERSONAL 8,ADV INJURY $ - GENEPALACCRE3ATE $ GEN'L AGGFE(,ATE-IMIT APFL iES PER: I PRODUCTS-CCbiP/OP AGO i PGLIC` - F' r^ LOC AUTOMOBILE LIABILITY j C011VOINED SINGLE LIMI1 $1,000,000 A ANY AUTC 2990900003 0610612007 0610612008 iEsaccident) ALL OWNED AUTOS BODILY INJURY $ x �SCHEDULED AJTOS Fe oersonl I HRED.AJTCS BODILY INJURY $ I I NON-CrXNIEDA.LROS jPe-eccident;i I PROPEF T Y CAMPG= $ R i Pe•accident; GARAGE LIABILITY AUTO ONLY-EA.ACCIDENT $ . :UJY AUTC .I I OTHER Th-AN EA.ACC AUTO ONLY: AGG I$ EXCESSIUMBRELLA LIABILITY EACH OCCURREP�CE OCCUR, 17 CLAIMS MADE AGGREGATE DEDUCTIBLE $ RETENTION $ $ 711, WORKERS COMPENSATION AND I �( WC SL.7L PIP EMPLOYERS'LIABILITY B ANY PRGPRIETOR,PARTNEWEXECUr VE WC687.56.51 0811012007 0811012008 E.L EACH ACCIDENT $5W,000 OFFICEWMEMBEF EXCLUDED' yes E.L DIS9ASE-EA EMPLOYEE $5WA00 P vas,describe uncer SPECIAL PROVISIONS beiow E.L DISEASE-PO!IC _IMIT $500,000 OTHER I ' DESCRIPTION OF OPERATIONS!LOCATIONS I VEHICLES!EXCLUSIONS ADDED BYENDORSEMENT I SPECIAL PROVISIONS Fax: 508.98.08H The Worker's Compensation pollcy does not provide coverage for Kevin W. Winters CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Roy Riley DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN 229 Maravista Ave NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR East Falmouth,MA 02536 REPRESENTATIVES. ' AUTHORIZED REPRESENTATIVE <EPM> 71 ACORD 25(2001/00) VfCORD CORPORATION 1999 f . CER - G t q N " i Gf/y� p �BOARD OF BUILDING = . License: CONST REGULgT1ONS RUCTIONSUPERVI3OR t Number CS 0375$9 ' r ��# B,�mw 2/36%1957 1 r a Rest 16Q'08 Tr.no: 1647 " D tncted AVID P JOHNSE) FA3 PALMER AVE All F�+, i1 �� t MOUTH MA 02540�� G` i Commission r . � a rya ik y t � _ � t tI L I a � _ - t �.0 k„ rfi x _ vy A bWVI An lit k I k�Mt Town of Barnstable. Regulatory Services ynRty�ABLE Thomas F.Geller,Director - ATFa9-��, Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 W"Aown,barnstable.ma.us Office: 5 09-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign. This Section If Using A Builder as Owner of the subject property. herebyauthorize �" d �► 0 30-4w4,&ov. 14#M�� to act on rriy behalf, in all matters relative to work authorized bythis building permit application for; . (Address of job) ature of er Date r t Name QFORMS:o'WW—UERMISSION o° TOWN rOF BARNBTABLE 24848 O r _ 'gK Permit No. __ ------ • Building: dnspector uassr i ; Cash i OCCUPANCY "'�PERIVIIT Bond ____`�___��ZS��3 Charles & Martha Converse Issued to ` Address Lots 227 & 229, 77 Maple avenues West Hyannisport Wiring Inspectors - —~^ Inspection date F" r®y-- Plumbing Inspector; ^ Inspection date (.� )1 Inspection date `7���a Gas Inspector ! � ��� Engineering Department Inspection date. 0-25 Board of.-Health JInspection date � "/✓7S 1 THIS PERMIT WILL NOT'BE VALID, AND THE BUIIDING S"ALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND IN ACCORDANCE 'WITH SECTION 1194'OF THE MASSACHUSETTS STATE BUILDING CODE. ` " �r..2TA :�..�.. 19. d- ......................... Building Inspector Ass'or's; map.and lot number .. h...-../..D..' ,Sewage Permit number ..... 3— S. M ��+p� -bs ��QyoF a ro�y� �- Z-INSTALLED IN CW-kl, ASU TAD i House' number �� .......... Vl/I II,. 9B mum LE ......................... ... ....... .................. ENVIRONMENTAL tT .''.,'0,,�1 39'Ar ...MAY ,. TOWN OF BAR, . STX Lr"� BUILRIHG' , IHS�PECTO t r APPLICATION FOR PERMIT TO : 4. .........................................::. ... 1:.......,..................................:.. TYPE OF CONSTRUCTION . ..... .: '.... - ?!il� - ...............: ......... ......... ...................................... ...................:C........................19........ TO THE INSPECTOR OF BUILDINGS: The undersig ed hereby applies' for a permit according to the following information: ro Location . .....................................................7 �1/l j...........................(.tJ>:....� v(Ifl1 01L ... _ ... ..... . .. F• .�� Proposed Use .............. .....D:. ....... ......................................... ..:............................................................................ l Zoning District ..... .............................44— W.6M. ciclress..... ...............Fire District ....... .... ......................... Name of Owner 4,� 1�!^ QJ {ham .. 2 ....5f�r��V k.t1.k...................... Name of Builder, ?. .. .! JB...a_ ...:................Address . "� ,. �✓I... ............... Name of Architect ... ..1vY.'�` ........................ ................Address ...................:................................................................. l b .�� Number of Rooms ..................... .................... :..........Foundation .... ......... Exterior ..��... .....,.. ....... ........ ...............:...Roofing .......... � ........................ ..:.. Interior ........Floors '�.�...�...`!.�'��-�.....:............... � ......... .................................... Heating ...q. .k .. ....... ` ................................. ........ .....Z ......................... Fireplace ..............1` " `- . ?...................................................Approximate Cost ...... ........................................... Definitive Plan Approved by Planning Board _____-----------� - -----�--------. Area ........ ..........�.............:.. Diagram of Lot and Building with Dimensions Fee ....... ................. SUBJECT TO APPROVAL OF BOAR D 'OF:HEALTH 4 Q 12 d OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS { 1 hereby agree to conform to all the Rules and Regulations of the own Bar s I re g ing the above _ construction. Na .....�..�. ...................... .................. ff�J �96� nstruction Supervisor's License ... .i1.1. ............. CONVERSE, CHARLES & MARTHA T ' 24848 One Story jJg ................. Permit for .................................... Single Family Dwelling ................................................................... ... Location Lots 227 & 229 AotO & Maple .Aves. :.. x West H Y P annis ort t x Charles & Martha Converse L. 'Owner . ......................................... . .................. ' , LA 4 Type of Construction Frame �' ' [_ t ................................................... ........................... - 4 Plot f.. ..................... Lot`................................ Permit Granted �.. t Niarch...11�......�....s�ijq 83 / y s,� .ue. : ` �3► Date of�p5�c ff`on .>�?....../... ......s..19' °..d - ' Date Completed ..... ........... G .Q '� l ► i� �' � _ { ..��. � . �. 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'(vVN►J OI= .3tSTA.31r AN'D 1� I:1dT LOCP.T D •WITN TN•6 FLOOD PLAIN �$� 3�••I PAT BAXT61 cz a AJ YC= INC. f j� 71115 PLaN 115 NoT gG%56A oa pN • RE�I���>���'►.A►rD�u�.v�Yves .I� OSTER•VILLFr • MASS• • Ma Sv2vGY 4'T oF -SWOUO , NOT DG 'Vjt 1"TL*v VG'TC V,1AI►•lCAPPLIIALiT =6a -W__„� v .�aN�Y Assessor's map and lot number ?�'Of I E Sewage Permit number .... 3"..., -��. .......................•., BARNSTADLE, i House number �� T� rAea .......................... ... 1639- 'Ep#I a TOWN OF BARNSTABLE BUILDING INSPECTOR w"i �"Vhal- APPLICATIONFOR PERMIT TO ............................................................................................................................. TYPE OF CONSTRUCTION .......... ... ? 14IN't,Q-............................................................................. ................... z. ................19 �.. TO THE INSPECTOR OF BUILDINGS: The undersig ed hereby applies for a permit according to the following information: .. . ---7 + 7-Z� L4"-K +....�A.4 ! It /4U6 � J- NILocation ...... . . .. 2Z ... ...................................... ....... ... ............................... ...... ... ...... .....................S �ofz r......... ProposedUse .... ..E.... ........................................................................... .................................................................. Zoning District .....1...................... ....... .............Fire District ...... . .. � ............................................. Name of Owner G � �JJ� � AddressGI3U............ ....IfII .............................. .! ,,,,I ? Name of Builderl.S........... ...................Address ..5M&Vv ..........Z...(.i...... . 4to Nameof Architect ....... ...........................................Address .................................................................................... Number of Rooms ............... Foundation ....t ............................................ .......................................Roofing Exterior ............................��...t......... .... ...... ............................................... a � r �c Floors �� Sr �.�!...4...������....................................Interior .......�ti..... �.`�-�-c-:.:` ' Heating . ..�.. ..w. - ............................Plumbing ...... ... ...;..................................... Fireplace �`f. ..................................................Approximate Cost } yl..... .......................................................... Definitive Plan Approved by Planning Board ---------------= -----. Area ........................ Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS / 1 hereby agree to conform to all the Rules and Regulations of the ow/�B s b` le regarding the above construction. Naje . ....................... Construction Supervisor's License .. ........................ iy CONVERSE, CHARLES & MARTHA A=1246-104 alb- lob No Permit for ...9ML.StorY......... Siag.19...k:4Mily..Dwe, ............ .............. ..... is Location ..LPts...2.2.7...&2.2.9...4.th...&..IFJZqM Aves ................We.!.i.t...Hyarmispart.................... Owner Maxt-ha...Canverse Type of Construction Frame............................ ................................................................................ Plot ............................ Lot ................................ Permit Granted ................19 83 Date of Inspection ....................................19 Date Completed ......................................19 ry ax 1 +21-711+ - Shower �CD o 50 X m _ lass -{� 41-711 }- _ TradeMark Professionals Drawing For: Mike Baker Sharon Braddock P.O. Box 607 48 Fourth Ave Marstons Mills, MA 02648 Hyannis Port, MA 02646 508-717-2982 1 TOWN OF BARN _ 2Q13 OCT 15 Fi i 3: 40 DI1IS j IN i _ I i ` I j