HomeMy WebLinkAbout0099 ISLAND AVENUE r
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Town of B17arnstable Building
vna 1 Post This Card So That it is Visible From the Str."eet Approved"Plans Must be Retained on lob and this Card Must be Kept
Posted Until Final Inspection Has Been Made 163
. t Where a Certificate of Occupancy is Required,such Building shall Not be Occupied until a Final Inspection has been made
Permit.
Permit No. B-19-3140 Applicant Name: Ryan Campbell Approvals
Date Issued: 10/02/2019 Current Use: Structure
Permit Type: Building-Siding/Windows/Roof/Doors Expiration Date 04/02/2020 Foundation:
Location: 99 ISLAND AVENUE, HYANNIS Map/Lot265-017 Zoning District: RF-1 Sheathing:
Owner on Record: REICH,SEYMOUR D TR Contractor Name>,, an Andrew Campbell Framing: 1
Address: 845 3RD AVE-8TH FLOOR Contractor License. CS=093716 2
NEW YORK, NY 10022 Est.Project Cost: $ 11000.00 Chimney:
i Y:
i
Description: Roof on garage € Permit Fee: $56.10
i Insulat on:
Project Review Req: Fee Paid: $56.10
Date- 10/2/2019 Final:
-' ryy Plumbing/Gas
Rough Plumbing:
\Building Official
`Final Plumbing:
This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months after`l'ssuance.
All work authorized by this permit shall conform to the approved application'and the approved construction documents for which this permit has been granted. Rough Gas:
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 Final Gas:
work until the completion of the same.
i� Electrical
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: Service:
1.Foundation or Footing
2.Sheathing Inspection Rough:
3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Final:
4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection
5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough:
6.Insulation
7.Final Inspection before Occupancy Low Voltage Final:
Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health
Work shall not proceed until the Inspector has approved the various stages of construction.
Final:
"Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A).
Fire Department
Building plans are to be available on site
All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT oW Final:
. Town of Barnstable
'�� 3, j. wilding
e 'PostWAS& Th;,n
'ard So".That�t is Visible"From"the Street A roved":FPlans Must be-Retained onJob--and this Card Must be"Ke t
`:a` " Posttil'FinWhere er96
tificate=`of OcCu anc, is Re wired such B:u�lrlm shall Not„be Occu red until a taenai Inspection,:has.ben made, ,� Permit
p t y. q .. '�..,,,. : ,gam; ..,. .•;: ;: .p,. ,:. :" .; : - :.,a. „ ,• ,-
Permit No. B-19-1554 Applicant Name: STEVEN L KADY Approvals
Date Issued: 05/14/2019 Current Use`. Structure
Permit Type: Building-Addition/Alteration-Resideritial Expiration Date: 11/14/2019 Foundation:
Location: 99 ISLAND AVENUE,HYANNIS Map/Lot 265-017 Zoning District: RF-1 Sheathing:
Owner on Record: RETCH,SEYMOUR D TR ' Cont actor NaQ, ,STEVEN KADY Framing: 1
Contract"or License 1 26014
Address: 845 3RD AVE-8TH FLOOR 2
NEW YORK, NY 10022 «e Est Project Cost_: $10,950.00 Chimney:
Description: Remove and Replace Center Chimney 6'Pan Flashed.Ro�ofl ne up Permit Fee: $105.85
Insulation:
Fee Paid x $105.85
Project Review Req: 3 -
Final:
D 1
ate 5/14/20 9
Plumbing/Gas
- Rough Plumbing:
Building Official -
Final Plumbing:
This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within'sik,.,hi'bhth:s,afteri.issuance.
All work authorized by this permit shall conform to the approved application and t i approved construction documents for which this permit has been granted. Rough Gas:
�e
All construction,alterations and changes of use of any building and structures sFiall be in compliance with the local zoning by8laws;and codes.
This permit shall be displayed in a location clearly visible from access street orroad-and shall be maintained open for public inspection for the entire duration of the Final Gas:
work until the completion of the same. i A
Electrical
The Certificate of Occupancy will not be issued until all applicable signatuures by the Building and Fire Officials areHprovided on thi permit.
Minimum of Five Call Inspections Required for All Construction Work:" Service:
1.Foundation or Footing r 4
2.Sheathing Inspection _ _ Rough:
3.All Fireplaces must be inspected at the throat level before firest flue lining is installed
Final:
4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection
5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough:
6.Insulation
7.Final Inspection before Occupancy
Low Voltage Final:
Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health
Work shall not proceed until the Inspector has approved the various stages of construction. t
Final:
'Persons pofttF9GtLQg,with unregistered contractors do not have access to the guaranty,fund" (as set forth in MGL c.142A).
Fire Department
Building plans are to be available on site
�� All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Final:
L,1U1-LDUVG DEPT.
p Application Number.... �i .................. ..............
UAY 0 7 019
BAltrtsrASLE, «MA98. � _ Permit Fee.......................................Other Fee........................
s639. TOWN OF BARNSTABLE — -- .
Fo nnrt
Total Fee Paid...............#./A� ....... ........... ......
TOWN OF BARNSTABLE Permit Approval by.................................On..... �...
BUILDINGPERNUT Map.... ..Parcel.........(................. ..........................
APPLICATION
Section 1 — Owner's Information and Project Location
Project Address_ I, IS1g4 gVC Village Rayli jeai j'
Owners Name flu0ju
Owners Legal Address �(9 -4,gy�
C p6KT State Zip G 7
j
Owners Cell# Q - E-mail Cq CC4_"Sk G C-�&ST- (JEi
Section 2 -Use of Structure
Use Group ❑ Commercial Structure over 35,000 cubic feet
❑ Commercial Structure under 35,000 cubic feet
❑ Single/Two Family Dwelling
Section 3,— Type of Permit
❑ New Construction ❑ Move/Relocate ❑ Accessory Structure ❑ Change of use
❑ Demo/(entire structure) ❑ Finish Basement ❑ Family/Amnesty ❑ Fire Alarm
Rebuild ❑ Deck Apartment El Sprinkler System
❑ Addition ❑ Retaining wall ❑ . Solar
❑ Renovation ❑ Pool ❑ Insulation
Other-Specify
Section 4 - Work Description
r � �
Last undated: 11/15/2018
Application Number....................................................
Section 5—Detail
Cost of Proposed Construction Square Footage of Project 1
Age of Structure Dig Safe Number
#Of Bedrooms Existing Total#Of Bedrooms (proposed)
110 MPH Wind Zone Compliance Method ❑ MA Checklist ❑ WFCM Checklist ❑ Design
i
Section 6—Project Specifics
Wirin T r❑ g ❑ Oil Tan
k Storage, ❑ Smoke Detectors
❑ Plumbing ❑ ❑ Fire Suppression 1
❑ Heating System Masonry Chimney ❑Add/relocate bedroom
•
Water Supply ❑ Public ❑ Private
Sewage Disposal ❑ Municipal ❑ On Site
Historic District ❑ Hyannis Historic District ❑ Old Kings Highway
Debris Disposal Facility: I am using a crane ❑ Yes ❑ No
Section 7—Flood Zone I.
Flood Zone Designation {
Within or adjacent to a wetland, coastal bank? Yes ❑ No ❑
Section 8-Zoning Information
Zoning District Proposed Use Lot Area Sq.Ft.
Total Frontage Percentage of Lot Coverage #of Dwelling Units(on site)
Setbacks Front Yard Required Proposed
1
Rear Yard Required Proposed
Side Yard Required Proposed
Has this property had relief from the Zoning Board in the past? ❑ Yes ❑ No
Last updated: 11/152018
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Commonwealth of Massachusetts
Division of Professional Licensure
Board of Building Regulations and Standards
Co6str6cti0 - ,jMW j Specialty
ires 1010312020 -
CSSL-059847 40 ,
STEVEN L KADY
PO BOX 493 lj r
FALMOUTH MA;0254�1Y �Sa
of-
Commissioner
� ���saer(pam�na��aea��G-�G?�ava�r�ccae%taJ '
Wice of Consumer Affairs:&Business Regulation�. ;
HOME IMPROVEMENT CONTRACTOR Ss
tr TYPEIridnntlual a�
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Re istr�y atio tation l
126014 04/07/2020
STEVENXADY '
STEVEN
I10FROCKLEDGE
yN FLMOUTH MAf02556> Undersecretary, _ .
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The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston,MA 02111
www massgov/dia
Workers' Compensation Insurance Affidavit: Bulders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name(Business/Organization/Individual):
Address: (1 ° V ►.�
City/State/Zip: E-�Ift Mck �(Phone#: d -IS IS
Are a an employer?Check the appropriate bog: Type of project(required):
1. I am a employer with- ), 4. ❑ 1 am a general contractor and I 6. ❑New construction
employees(full and/or part-time).* have hired the sub-contractors
2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling
ship and have no employees These sub-contractors have g, ❑Demolition
working for me in any capacity. employees and have workers'
9. ❑Building addition
[No workers'comp.insurance gyp.insurance.:
required.] S. ❑ We are a corporation and its 101-1 Electrical repairs or additions'
3.El officers have exercised their I am a homeowner doing all work 11.El 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 afdavit 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.#;� �_ I� Expiration Date:
Job Site Address: �� 5�'cl_ City/State/Zip:�`SCS�h�{ N'1�
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.
1 do hereby certify u ndre ams nalties ofpe ' ry that the information provided above is true and correct
Signature: Date:
Phone#: 5�
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.Chy/rown Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
i
Information and Instructions
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 iri 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,constzuction 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 time 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 time 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 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 burn 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
Dgwtment of Industrial Accidents
Office of Investigaflm
600 Washington Street
Boston,MA 02111 -
Tel.#617-727-4900 eut 406 or 1-877-MASSAM
Revised 4-24-07 Fax#617-727-7749
►,mass.gov/dia .
Tigerlilly Day Spa 508-543-7800 p.1
Steven Kady Phone. 508-563-2515
Ma. Licensed Construction Supervisor#059847 Noll free:800-567-9787
P.0 Box 493
Falmouth, Ma 02541 -
Cell:508-566-6087
Fax: 508-563.2516
Email: Steve@SteveKadyMasonry com.
www.SteveKadyMasonry.com
PROPOSAL May 2,2019
Paul Parece
99 Island Ave.
Hyannisport, Ma. 508-367-6728
Pgarece1950(cDgmail.com
Pauline Skiver
10 Oceanspray Lane
West Yarmouth, Ma. 02673
CapeCodSkyOcomcast.net
WORK TO BE PERFORMED:
* Construct ground&roof staging
• Remove center chimney down to roof line
o Chatham Panflash &raoxistruct chimney
o Using Boston Colonial Brick,w/detailed crown
o Install stainless steel chimney cap
One cube of hick,for matching color purposes ADD: $750.00
TOTAL: *Labor, Material,Disposal&Building Permit: $10,200.0(
TOTAL: $10,95o.ol
WORK TO BE PERFORMED: STEP&PLATFORM ,.
• Remove front step&platform
• Re-construct front step,w1 Boston Colonial Brick risers and bluestone tops
TOTAL: *Labor, Material,Disposal: $6.900.00
*I f new footing is required,ADD: $800.00
DEPOSIT DUE. $4925.00 Srgnat �e:
50% to Schedule balance due upon completion
E:
Application Number...........................................
Section 9- Construction Supervisor
Name !Sj 1� I "C�{(�/ Telephone Number
Address b�0 City State [ Zip
License Number O License Type C Expiration Date �0
r Gt�
Contractors Email (�J:-VE ® SMIJ `�� C Cell #
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 inspection procedures,specific inspections and
documentation require 780 CMR
-_ Town of Barnstable.Attach a copy of your license.
Ane
7-Signature Date &-
j
Section.10—Home Improvement Contractor
! Name_ _ aCVe �C �' Telephone Number
Address Ed 60Y City I'qi kva h State Zip (2
Registration Number Expiration-Date
I understand my responsibilities under the rules and regulations for Home Improvement Contractors in accordance with 780
CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and
documentation required 780 C e Town of B astable.Attach a copy of your H.I.C...
Signature Date �✓7—
Section 11 —Home Owners License Exemption
Home Owners Name:
Telephone Number Cell or Work Number
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 inspection procedures, specific inspections and
documentation required by 780 CMR and the Town of Barnstable.
Signature Date
APPLICANT SIGNATURE
IkN
' Signature Date S- 7' f`(
Print Name STEM f<1+0Y Telephone Number
E-mail permit to: ST(Vl=� o � y� k� (QSur/2 • Co 11
Last.updated: 11/152018
Section 12—Department Sign-Offs
Health Department ❑ Zoning Board(if required)
Historic District ❑ Site Plan Review(if required)
Fire Department ❑
Conservation ❑
For comm_ ercial work,Please take Your ans dire ctlYR to thejre�Partmentfor approval,
Section 13— Owner's Authorization
as Owner of the.subject property hereby
authorize to act on my behalf, in all
matters relative to work authorized by this building permit application for:
(Address of job)
l
Signature of Owner date
Print Name
Last updated: 11/15/2018
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1 COMMONWEALTH.
OF
DEPARTMENT OF PUBLIC SAFETY a
ONE AS ON PLACE
I p MASSACHUSETTS
BOSTON,MA 02108 Fo�Iais to pp taaas
"'m�saobaiottastati went
EXPIRATION DATE CONSTR.LICENSE S V I S O R Qodo%ooaso for r�;�V
0 3/08/199 b Itb/o/Itra+�.
RESTRICTIONS EFFECTIVE DATE
NONE LIC-NO. FOR PROTECTION AGAINST
-06/X/1993 005609 THEFT, PUT RIGHT THUMB
'6 PRINT IN APPROPRIATE
1ftUVNREY BOX ON LICENSE. 0SLLIA p78 o
Z W YARMOUTH MA C2673
BLASTING OPERATORS
PHOTO(BLASTING OPR ONLY) F b 0.00
-.m r MUST INCLUDE PHOTO.
m
HEIGHT:
NOT VALID UNTIL SIGNED By LICENSEE AND OFFICIALLY '
STAMPED-OR-SIGNATURE OF THE COMMISSIONER '
; � � <i;
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THIS DOCUMENT MUST B
v CARRIED ON THE PERSON
OTHER THE HOLDER WHEN EN- U « SIGN ME IN FULL ABOVE SIGNATURE LINE
MB PRINT GAGEDINTHIS OCCUPATION. ICENSEE NAME,
t COMMISSIONER
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7T-771- T77T--'7'
77
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Pt Ippe5 Jaye -t—
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I load
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Assessor's office(1st Floor):. yy
Assessor's map and lot nu Floor)*,
/ � i TeIr>o``
Conservation(ath Floor): —` o1q h1ar.a � U -� e
Board of Health(3rd floor): _ P 1� tl j `' •
Sewage Permit number -'� `f ��•� �y '� �k���f +�a����"�� �' t s��T�ttJo�:
MASK
1 i. e741C�7N Ti0 PEE 5 ~�O s639..
Engineering Department(3rd floor)';
House number C�r�-c/ ENVIROX9E���i TAL CODE ANDY�r
Definitive Plan`Approved by Planning Board ' � � H 4 GULAF10NS
APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2:00 P.M.only
TOWN OF - BARNSTABLE
BUILDING INSPECTOR
APPLICATION,FOR PERMIT TO Q
e
TYPE OF CONSTRUCTION
19
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according to the follow' g informatiogi
Location — —y�Lit10 �7v�
i Proposed Use
!t
Zoning District Fire District
Name of Owner ', ®I ffe/Uetde , Address 9T v
Name of Builder e�wce- Aleh C s Address 00 s0 0�6tv 17/
Name of Architect Address
Number of Rooms Foundation
Exterior Roofing �—
Floors Interior
Heating Plumbing
Fireplace Approximate Cost O 0
Area ��
Diagram of Lot and Building with Dimensions I Fee
r
OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS
I hereby agree to conform to all the Rules and Regulations of the Town of Barnstabl arding the above c nstru n.
Name �)�cv A t-j.o e- n• Q�N
Construction Supervisor's License
KENNEDY, JOAN 4 _
1 No Permit For BUILD SUN DECK. & REPLACE WINDOWS
Single Family Dwelling =
Location _Lots 2A, &2B, 99 Island Avenue
Hvannisl2ort
L• ` c \
Owner Joan Kennedy
Type of Construction Frame , J
Plot - Lot
a
Permit Granted` March 29 ,
Date of Inspection:
Frame 19
Insulation 19 - -
Fireplace 19
d �
s
Date Completed L 19 _ •� _ _ I
• I ,
• .i ,ram f -�,' ,i, , ' ,!� v 1..
,V ,
Engineering Dept. (3rd floor) Map �J Parcel 7 Permit#
House#_ C? .Cj F Date Issued
Fee
C - - .00) _
P Wig) INEby ►p�,-
19 �`�
BARNSTABLE.
MAWCL
TOWN OF BARNSTABLE
Building Permit Application
P ec 't Address q 9 :l S�AA//� f�( _ il!({i� � 1/ o,�A 2B
Village MIAJ//,UoSpo!'T
Owner d�� \8. / ,t/,�� t/ Address /np
Telephone 5'D9 ) "77/ — yg/V
Permit Request
First Floor square feet Second Floor square feet
Construction Type
Estimated Project Cost $ /�/�.SQQ,DQ
Zoning District Flood Plain Water Protection
Lot Size Grandfathered ❑Yes ❑No
Dwelling Type: Single Family Two Family ❑ Multi-Family(#units)
Age of Existing Structure Historic House ❑Yes ❑No On Old Kings Highway ❑Yes ❑No
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%A{aad®/e L. gann jl;, ,OJ ,., Telephone Number �5_,O?) 775 - 776a
Address /p.Q , &OX 7zz License#
- &AaJ5Ub6&' 0�^l�le Home Improvement Contractor#
Worker's Compensation# g",o I/ qq9 26
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 BETAKEN TO �/f g,PDU7 A
9 If I
SIGNATURE
T
BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S)
FOR OFFICIAL USE ONLY
PERMIT NO.
DATE'ISSUED
MAP/PARCEIJNO.j
A y
ADDRESS': VILLAGE
a R
4 �1
OWNER
DATE OF INSPECTION: ;
FOUNDATION
FRAME 1 _
INSULATION
FIREPLACE
ELECTRICAL: ROUGH FINAL
PLUMBING: ROUGH ! FINAL
GAS: ROUGH FINAL '
FINAL BUILDING -
DATE CLOSED OUT
ASSOCIATION PLAN NO.
n+e r
The Town of Barnstable
BARMAEM
Department of Health Safety and Environmental Services
Building Division r
367 Main Street,Hyannis,MA 02601
Ralph Crossen
Office: 508.790-6227
. Building Commission
Fax: SO8-790-6230
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.
T e of Work: Est.Cost /5( TA
Yp
Address of Work: �//A-��� ��/��» ���A ` L�/��lAl/S•PDI�
Owner's Name
50�4t1� ��i(�/ll2.�tJ
Date of Permit Application:_ /L/3,Zy& - f'
I hereby certify that:
Registration is not required for the following reason(s): k
Work excluded by law
Job under S1,000.
Building not owner-occupied
Owner pulling own permit
Notice is hereby given that: UNREGISTERED
OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH
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 gent of the owner.
co
ntractor
tra ctor Name
& d,7
Registration No.
Date .
�.: OR
V The Commonwealth of Massachusetts
r Department of Industrial accidents
o OJ1/OOOJ/oYaitly�d(1/i
600 Washington Street
Boston,Mass. 02111
Workers' Compensation Insurance Affidavit
Aoolicant intormadoQn: p PleascPRIN7`leos�hr
name.:
location
❑ am a omeowner performing all work myself.
I am a sole proprietor and have no one working in any capacity
0 lam an employer pro%iding workers' compensation for my employees working on this job.
comnvname Theodore L. Hitchcock
address: P.O. Box 211
W. Barristahl e phone No SOS 1 775-77F'2
insurance - Travelers policy 807K449-0-96
I am a sole proprietor. general contractor, or homeowner(circle one) and have hired the contractors listed below.%%ho ha%
the follo%%ing workers' compensation polices:
a-d dress,
.. Dhnn•a• ---
Murince co.
to-mliany name!
My: phone me
insurance co-
DOIICV�
w
Failure to secure coverage as required under Section 25A of MGL 152 as lead to[Be imposition of criminal penalties of a oat up to 51�00.00 and
one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a one of$100.00 a day against mt. I understand tba
copy of this statement may be forwarded to the Office of Investigations of the DU for coverage veriliation.
do-hereby c ify under the pains and penalties of perjury that the information provided above is trite and cornet
• Signature
ale
Print name Theodore L. Hitchcock Phone# ( 508) 775-7763
official use only do not-&rite in this area to be completed by city or town oMcW
permitAicense M nBuilding Department
city or town: _ _ (3Uce"og Board
C3Selectmeu's Office
check if immediate response is required Health Department
contact person phone N:_
nOtber
(revised 3,95 PJA)
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Y I HOME IMPROVEMENT..CONTRA:CTOR'
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.> Registration 10,8918
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HETCH
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